Black History Month celebrates the many accomplishments of members of the African American community. Although this month is exceptionally observed, it is critical to bring awareness to the social and health disparities and the historically inequitable policies that affect older African Americans in long-term care.

Race-Related Stress and the Impact on African American Seniors

Research indicates that stressors, such as overt racial discrimination, have a negative impact on the mental and physical well-being of African American seniors. Race-related stress occurs when an individual experiences or witnesses (a) racist incident(s) that evoke historical experiences of racism. Exposure to such racist incidents has resulted in limited access to resources for African Americans of all ages. These resources include, but are not limited to, education, healthcare, transportation, and political participation.

This denial of access leads to health disparities and a decrease in physical and mental well-being. There are higher rates of mental illnesses among African American elders, such as anxiety, depression, and dementia. Unfortunately, race-related stress is a barrier to achieving and sustaining a healthy life for African American seniors.

The History and Inequities of Medicaid

Health insurance programs such as Medicaid are vital to ensure affordable healthcare. However, systemically discriminatory policies have led African Americans to rely on this program. The aging African American population is a highly vulnerable group. During their working years, African Americans are less likely to have accumulated wealth when compared to white counterparts. As they age, this population commonly experiences financial instability.

Relatively few African Americans have the option of living in upscale, private-pay nursing homes. Instead, African Americans must rely on Medicaid to fund necessary long-term care services. In fact, 93% of the nursing home population in the City of St. Louis uses Medicaid to pay for long-term care. Out of VOYCE’s 28 county service area, the City represents the poorest population, and the largest African American population, that we serve.

You may ask yourself, “How did this happen?” The practice of redlining has largely influenced this social inequity. “Redlining” is defined as a discriminatory practice that puts services out of reach for residents of certain areas based on race or ethnicity. It was exemplified in the systemic denial of mortgages, insurance, loans, and other financial services based on location. These denials occurred in areas like inner-city neighborhoods that were deemed “hazardous” or “undesirable.” Lenders placed a red line around these neighborhoods to ensure that residents were denied loans or insurance. Though legally banned, the effects of redlining still significantly impact minority residents today.

What it means for African American long-term care residents

Long-term care communities in inner-city, low-income communities are more likely to be denied resources and funding due to less interested investors. As a result, residents of these communities are overlooked and continue to receive disproportionate care.

According to the Nursing Home Abuse Center, black Americans are three (3) times more likely to reside in poor performing or otherwise lower quality nursing homes than white Americans. This is concerning for many reasons. To start, poverty rates are correlated with poor quality of care. The higher the percentage of Medicaid beds in a long-term care community, the lower the quality ratings for care delivery tend to be. Nursing homes in low-income areas, such as the City of St. Louis, are vastly underfunded. As a result, they are understaffed, and existing care staff are underpaid and overworked. This low-quality standard for nursing homes has, in part, contributed to the health disparities that exist among older African Americans.

It is no secret that the nursing home population, as a whole, experience a variety of serious health concerns. However, older African Americans are more likely to experience multiple, co-occurring health problems. They are also more likely to start experiencing these issues at an earlier age.

The Forward Through Ferguson report notes an 18-year gap in life expectancy between people living in the Clayton (life expectancy of 85 years) and those living in the Jeff-Vander-Lou neighborhood (life expectancy of 67 years).

According to other research, African Americans have a higher risk of serious health conditions like heart disease, hypertension, and diabetes than white people.

Moving Forward

African Americans, young and old, are a continuously underserved population in our society. At VOYCE, we are always looking for new, effective ways to best serve this vulnerable population. Fighting against deeply-rooted systemic problems requires work from everyone in the community. As the aging population continues to grow, awareness and available resources must follow suit. Here are a few things that advocates for the aging community can do this Black History Month:

  • Advocate for African American seniors at the individual, local, and state level.
  • Become educated on the history of disparities and injustices faced by African Americans.
  • Report all instances or suspicions of elder abuse, neglect, and isolation.

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