How Long-Term Care Facilities Can Recruit Diverse Elders

Most long-term care (LTC) facilities have one thing in common: a lack of diversity and an inability to recruit minority elders, according to Steve Moran, president of Senior Living Foresight. "Residential LTC has 'an ethnicity problem' and today, based on resident populations, only white people (and Asians) seem to like them," he says.  

How can the LTC industry address this problem? But more importantly, how can they find ways to diversify these communities? Many reasons and explanations exist for the lack of diversity among LTC residents, from minority elders who prefer aging/living at home to retirement communities being expensive. 

Research suggests that if staying at home is no longer possible, most older adults prefer moving to assisted living rather than a nursing home. But Black older adults are likelier than white older adults to choose family care at home and less likely to prefer assisted living. 

Access to assisted living may also be a greater challenge for Black rather than older white individuals since, on average, Black older adults have fewer financial resources. The same goes for Hispanics compared to white older adults. While these issues are valid, they do not tell the whole story due to insufficient data. 

Only a few studies have examined the distinct pathways to help explain Black and white disparities in different types of LTC use. Using the same narrative around racial disparities only stifles change that can help create a more equitable, unbiased LTC system.

Past studies show another dialogue, one that's largely been ignored but shows momentum, is in minorities and younger adults interested in residential LTC. For example, a 2016 Caring.com survey indicated that more young people of all races were more open to assisted living than people 65 and older. 

Hispanics and African Americans are much more open to LTC communities, and the data shows that 49% of Hispanics and 46% of African Americans would consider living in one of these communities. And 64% of Whites would consider placing a parent in an assisted/ independent living facility versus 37% of African Americans and Hispanics.

Just like any other demographic group, minority elders are not monolithic. Some prefer to age in place, others may not, or only select respite care services. If retirement communities want to attract a racially diverse group, they need to improve on what's working and end what's not working. 

Researchers have suggested that unmeasured factors related to systemic racism (for example, residential racial segregation, racial discrimination) and Black and white differences in care preferences might further explain the disparities in moves to assisted living and deserves further investigation. 

Elder abuse is another big issue. Almost ten years ago, PBS Frontline produced a documentary titled "Life and Death in Assisted Living." The documentary examines the operations of the nation's largest assisted living company, raising questions about the drive for profits and fatal lapses in care by a loosely regulated industry. But many years later, elder abuse is still an issue that puts older adults at risk. 

Current investigations show that long-term care residents are vulnerable to elder abuse, neglect and exploitation, although it's worth noting that most cases of elder abuse extend from family members. Therefore, a healthy environment is also critical for older adults living with loved ones. 

Elder abuse requires more awareness, from educating people about recognizing and preventing abuse to increasing reporting numbers, as elder abuse is under-reported.

Approaching these issues is critical for LTC even if efforts seem futile and the quest for more inclusive residential facilities is challenging. It will require a holistic approach, like training staff about unconscious bias, improving cultural competence and expanding creative care options to offer more choices. 

It may also involve a radical change in how residential facilities do activity programming to engage current residents and attract future ones. And this means having a person-centered approach and working to achieve that.

What do residents like? What would they choose to do? 

And the big question: What help would they want? And how can they feel at home? While the industry can only solve some things regarding making their communities diverse, there is an opportunity to innovate and think outside the box. 

It means that LTC communities can capitalize on laying the groundwork to target younger generations and work with today's caregivers as they care for their loved ones. For example, respite care is an untapped resource that families can use when needed. It may be a start for them in learning more about long-term care and its main features. 

Seeking respite care can help ease the burden of family caregiving, relieve stress and prevent social isolation. Like the recent trend of working with families to learn more about their resident loved ones is gaining traction, retirement communities can also create new directions in their policies and diversity strategy.

Research has shown that minority elders are interested in assisted living, so assuming otherwise is a disservice and keeps LTC from innovating and moving onward.

It is gaining a diversity of thought and discourse that can influence residential communities. As Moran explained in reference to Black consumers overall: 

"Specifically, when they [Black older adults] look at the content they are looking for, hoping for and wanting ethnic diversity, which suggests, when they see diversity, they will think better of your brand and be more likely to consume your brand." 

Pursuing diversity is necessary, but it shouldn't be superficial because it can prevent efforts in recruiting and retention. The first viable step is the LTC industry striving to lift all voices, including marginalized ones. It will take a targeted approach to engage other ethnicities in residential LTC and change perceptions of what older adults want or how they should be.