This article originally appeared in the Aging Life Care Association blog: blog.aginglifecare.org and has been edited slightly to conform to ASA style standards.
For more than 400 years, black and brown communities have experienced systemic racism and intergenerational trauma. In 2020 and 2021, we continued to experience these traumatizing events portrayed through violence, dehumanization and oppression. The disparities among black and brown communities have been marginalized and minimized by many for so long that some have given up hope and no longer recognize “I have a Dream.”
As a result, historically, black and brown people learned to trust only within their circles and question all others’ motives. Because of this inner-circle trust level and distrust of others, black and brown individuals continue to suffer. We unconsciously deprive ourselves of a level of resilience. We mistrust the system, so we do not seek appropriate help or support from experts, such as mental health counselors and professional care managers.
As a Black care manager and psychotherapist, it is my responsibility to foster resilience and hope for change again. While on the cusp of this change, it is essential to help my colleagues better understand why many black and brown individuals are resistant to hiring a care manager or seeking mental health support. The list below is not inclusive.
- Lack of understanding the culture and environment: Historically, black and brown families developed inter-family systems where family members take turns caring for their elder loved ones. For example, as a kid (age 12), my siblings and I had to learn how to feed my grandmother through a feeding tube. During this time, you used a syringe to push the pureed food through the tube. Sending my grandmother to a nursing home was not an option. Also—just because there is an HCS (Healthcare Surrogate) or POA (Power of Attorney), that does not always mean that people always make independent decisions. Often, there are conversations between family members before the POA or HCS makes a decision.
- Fear and distrust: Fear and distrust “of the system" creates barriers for black and brown families to engage an outside expert (care manager or mental health therapist) to assist with their elder family member's needs. Therefore, many do not see it as a value and will not invest in services. As a care manager, you must work closely with family members and the elders to gain their trust and dispel their perception. For example, do not pretend or say you understand their challenges without exploring their experiences (such as with medical providers, mental health therapists, or insurance case managers). Reminding black or brown clients that they are the expert of themselves, and the relationship is a partnership.
Before taking a referral or engaging in discussion with black or brown families, dispel all assumptions and cancel judgment.
- Miseducated or uneducated: Many individuals are miseducated or uneducated about their medical insurance benefits. As an experienced medical social worker, I worked in the hospital for more than ten years and encountered many patients who were informed by a neighbor or another family member that their insurance covered custodial care needs. Or that their medical insurance benefits included a care manager. Educating individuals about the differences in services is essential. But keep in mind, you must spell out the word V-A-L-U-E as a conversation. Increase their knowledge of Viable options; Advocacy; giving meaning to their quality of Life; Understanding their differences and how they view the world; and showing how much more Effective and Efficient actions are taken when an experienced care manager is involved.
- Value of spending money on care management services: When you compare the socioeconomics between black and brown families and their counterparts, black and brown families have an extensive history of poverty and often, limited access to financial resources. It is not that black and brown families do not value money or other financial resources; they usually do not see the value of spending money on care managers’ services.
- Lack of self-reflection and acknowledging your stuff: Many of us are comfortable in our role as a care manager, which can be somewhat dangerous when engaging black and brown elders and their family members. Words or phrases we use, or our body language, can be offensive. Phrases like “when you people,” “my black friend,” or “I had a black supervisor that was great,” or “these people are nice” are not productive or effective rapport-builder conversations. Before you take a referral or engage in discussion with black or brown families, dispel all your assumptions and cancel judgment.
- V—to increase Viable options of which family members may not be aware. (As a care manger, it is our role to ensure our clients know they have viable options and that the one the medical provider suggested isn’t the only one).
- A—show how in your experience “It takes a village,” even as we get older. As a care manager, we aid in Advocating for clients and family members. No person should ever feel like he or she is in this alone.
- L—giving meaning to quality of Life is important. As a care manager, it is our role to be honest and meet the family and clients where they are. Explore what quality of Life looks like to them because changing their diet is not a measure of their quality of life.
- U—showing your client that you want to Understand their differences and how they see the world is a great way to start a partnership. For example, explore whether your black or brown client prefers to have medical providers that look like them.
- E—emphasizing and showing how much more Effective and Efficient actions are when an experienced Aging Life Care Manager is involved.
Kizzy Chambers MSW, LCSW, CMC, is an advanced professional member with the Aging Life Care Association. Chambers is deeply involved in national ALCA committee work serving on the Diversity & Inclusion Task Force and regionally as a board member for the ALCA Florida Chapter and the Florida Chapter Professional Development Committee. You can contact Chambers via her website at www.rrcaremanagement.com.