Editor’s note: The John A. Hartford Foundation, the Administration for Community Living (ACL) and The SCAN Foundation fund the Aging and Disability Business Institute, led by USAging. The mission of the Aging and Disability Business Institute is to build and strengthen partnerships between aging and disability community-based organizations (CBO) and the healthcare system. As partners in the Institute, ASA and USAging are collaborating on a series of articles and case studies in Generations Now that highlight efforts to promote equity in aging.
Health equity can sound like a vague, distant concept, conjuring images of dismissive patient treatment in a doctor’s office. But AgeSpan in Massachusetts has brought it down to an approachable level with anti-racist, pragmatic and much appreciated practices and training. As well as elevating better training to the funder/healthcare provider level, too.
Jennifer Raymond is chief strategy officer for AgeSpan, which recently celebrated 50 years of providing the social care services people need so they can live safe, healthy lives at home in the community of their choice. AgeSpan is in the Merrimack Valley, and Raymond works in Lawrence, Mass.
Of the 28 cities and towns in the AgeSpan catchment area, 2 are the poorest communities in Massachusetts and 4 are gateway communities—they boomed when textile manufacturers dependent upon the river were thriving, but those industries long ago dried up and many towns are now impoverished. This area also includes 3 of the top 20 communities in the state in per capita income. In other words, AgeSpan must be deft at dealing with a wide swath of humanity in its social care services, and one way they do that is through extensive training.
AgeSpan’s Cambodian clientele can dine out in Cambodian restaurants and connect with friends and neighbors, courtesy of an AgeSpan program.
A bit about AgeSpan’s work: Raymond said its greatest strength is on the social care side, in the home, and making connections with healthcare partners. It has contracts with accountable care organizations (ACOs), managed care plans and federally qualified health centers.
It also holds contracts with hospitals in which AgeSpan social workers and staff are embedded, to facilitate older adults as they prepare for discharge, where they set up meal delivery, get someone do to laundry, help patients navigate their home, and even do home modifications as necessary. Some of their contracts with ACOs across the state invest in and pay for nutrition and housing services for their members.
Diverse Staff and Customers, Complex Challenges
AgeSpan employs a staff that is 36% Latino; and has a customer base in Lawrence that is 82% Hispanic or Latino. Another town covered by AgeSpan is Lowell, which boasts the second largest community of Cambodian immigrants and refugees in the country, second only to Long Beach, Calif. The area’s population is exploding, said Raymond, which means AgeSpan needs to repeatedly build strong, trusting relationships between the agency and its clientele. To that end, AgeSpan partners with other local community-based organizations (CBOs) to effectively build meaningful relationships and provide culturally appropriate services to its diverse customer base.
It is complicated work and there has been a learning curve since 2020, when AgeSpan first began talking not just about diversity, but about building equity and inclusion—particularly health equity. One of the simplest illustrations of how this works is when the people at AgeSpan realized that just because the home-delivered meals they were providing were nutritious did not mean they were popular or even being eaten by people they were meant to feed.
That’s when AgeSpan happened on the idea of the restaurant program, wherein the agency pays restaurants for meals for its Cambodian and Latinx clientele who are food insecure, so they can frequent some local restaurants, order off the menu like regular diners, and gain the added benefit of socializing with friends and neighbors.
Raymond went so far as to say that at AgeSpan they recognized they had a history as an organization that, through some of their services, were being unintentionally inequitable.
“I think of services like home-delivered meals, which are great for feeding people, but it means everyone gets grilled chicken, potatoes and beans on Tuesday, and we had a history when we talk with our Latino and Cambodian populations, with saying, ‘well, this is what everyone eats!’ ”
‘Within the past 5 years healthcare and social care providers have begun to acknowledge the connection between racism/racial structures and health equity.’
As an organization they had to admit this practice was inequitable. “We’re not honoring their cultures, so how do we bring our clients their cultural meals, and how do we make our medically tailored meals more culturally appropriate?” Raymond asked. Until two years ago if you were Hispanic and had diabetes, you had to choose between a “Hispanic meal” or a “diabetes meal,” but you couldn’t combine the two.
Now AgeSpan has launched a service line with medically tailored Hispanic meals. This, combined with the Cambodian restaurant program, are just two of the ways it has chosen to foster an anti-racist, health equity initiatives.
Inequitable Treatment and Anti-Racist Training
Inequity shows up not just in lack of food choices, but also when customers go to the doctor and feel neither seen nor heard. They are not looked in the eye, but instead the physician concentrates their energies on interacting with the patient’s translator and typing up case notes. Granted, this also happens with older white people (minus the translator), but either way the patient feels they are “being othered or considered less than,” said Raymond. Sometimes it’s a language barrier, sometimes it’s a racial one.
Similarly, AgeSpan staff, when going into people’s homes, can be treated as less than by the clientele. “We’re talking about racism, or sometimes it’s ableism, and sometimes it’s sexism,” said Raymond.
Raymond is proud to note that within the past 5 years healthcare and social care providers have begun to acknowledge the connection between racism/racial structures and health equity, and especially in the past 2 to 3 years the movement has been toward investing in addressing the issue of structural racism.
AgeSpan holds two types of trainings for its staff, within their first 6 months on the job they participate in Diversity, Equity and Inclusion training, which begins to address the concept of structural racism. Then there is ongoing training related to day-to-day racism they may feel, how to identify it, and training managers at what point it may be necessary to intervene and remove staff from the situation, if it’s deemed unsafe.
Also, AgeSpan conducts training with its board and senior and middle managers, who do the hiring. That training covers implicit biases related to race and culture that everyone carries around but may not want to admit.
“Lots of people talk about this work as health equity or eliminating health inequities without going so far as to say that includes eliminating structural racism. I think Massachusetts is more progressive in that there’s a push to say it would be great to provide culturally appropriate meals, as we call it Food as Medicine, but as long those structures still exist that support marginalizing populations it’s not going to work. We’re careful to call them out as different (health equity vs. racism) but in order for one to survive the other has to die,” said Raymond.
Alison Biggar is ASA’s editorial director.
Photo credit: Shutterstock/SALMONNEGRO-STOCK
