The New Old Age - Caring and Coping
March 2, 2011, 8:55 am
How Race Complicates Care
By PAULA SPAN

She thought her father, who was 70 and a retired teacher, could use some help. He handled all his personal care, but shopping and cooking and laundry were beginning to tax him. He’d fallen several times.

So she started looking at senior housing options, both in Florida, where she lived, and in South Carolina, where he did.

At the first facility, the daughter — to preserve the family’s privacy in this delicate matter, I’ll refer to her as B. — noticed something she hadn’t thought much about before. “The place was pretty white, for lack of a better phrase,” she told me in an interview. Her family is African-American.

When B. asked the director about diversity, “She said, ‘Oh, we’re very diverse. We have a lot of people who’ve moved here from Europe.’” This wasn’t what B. had in mind.

Her father had grown up in the segregated South. “High school and college were all-black experiences for my parents,” she said. So was the church so central in their lives. They knew white co-workers, of course, but rarely socialized with them after hours.

Would he be comfortable being one of a small racial minority in an assisted living community? Would white people in their 80’s and 90’s, probably similarly unused to social relationships with blacks, be comfortable with him? “You’re living together, you’re eating together — it’s different,” B. said. “This is a pretty big shift to make at his age.”

She kept looking, her father sometimes accompanying her as she visited possible homes. They took to telling each other, “We didn’t see a lot of us there” — except as staff.

On to the next step. Her father decided he didn’t want to give up his privacy and move after all, so B. contacted a home care agency, hoping to hire someone to come in several hours each day to help with housecleaning, shopping and meals. The agency said it had just the person.

“They sent her over to meet us,” B. recalled. “They’d described everything to her in advance. She met him; she met me. It’s 2 in the afternoon, and at 8 that night the agency calls to say she’s changed her mind. The only thing that had changed was that she’d met us face to face.”

The woman was white, in her 30’s, less educated than the man she’d be assisting. Was that the issue? B. felt reluctant to come to that conclusion. “It might be too few hours for her,” she said. “Or maybe she just thought, ‘I don’t like that guy.’”

But she has come to this conclusion, which is what led her to contact me: Race matters more in senior-care decisions than people may recognize, or care to talk about.

Research has documented a number of racial differences. We know that black seniors have poorer health and greater disability than whites, on average, and shorter life spans. We know that black families are more likely than whites to share residences with elderly parents, which may be due in part to economic factors. We know that in nursing homes and assisted living facilities, a combination of heavily minority staffs caring for mostly white residents can lead to tensions.

But we also know that families respond to intangibles, different understandings of what’s expected.

B. has felt these pressures herself. “I’ve always heard, ‘We don’t do that. We don’t send our mothers and fathers off to nursing homes. We take care of them ourselves,’” she explained. In recent generations, she points out, black women with careers are less able to provide daily care for parents; at the same time, middle-class black families are better able to pay for alternatives. “Our situation has changed, but our ideas haven’t,” B. said.

Further confirmation that those ideas retain their force came from a study, recently published in The Gerontologist, that looked at more than 600 middle-aged black and white adults in the Philadelphia area who had both grown children and aging parents. The researchers found that while both races felt obliged to help their parents, the whites were more likely to provide support (including time, money and attention) to their children, who were more apt to be pursuing higher education. Black families tended to provide greater support to their elders.

Economic and health differences didn’t explain the difference, said lead author Karen Fingerman, a Purdue University gerontologist. “It was the feeling of obligation. You’re supposed to help your aging parents — it’s your job.” Black families also described helping their parents as more rewarding and satisfying than whites did.

Those distinctions are small but statistically significant. Both racial groups acknowledge a sense of duty. But on a 5-point scale, whites averaged 3.9 in their feelings of obligation to help parents, while blacks averaged 4.3. Asked how rewarding they found it to help parents, whites scored an average 4.0 and blacks, 4.3. “There are differences in how we feel, in what we’d call cultural beliefs,” Dr. Fingerman said.

B.’s father remains at home for now. A middle-aged African-American woman comes to help him.

B. wonders if this generation will be the last for which racial comfort will be important. At 40, she has gone to integrated schools, has always had white friends, attends a largely white church. Decades hence, she’s not sure she’ll be worried about the ethnicity of her fellow assisted living residents. (I wonder, too, if boomers will be so concerned about religion, about moving into a Catholic or Lutheran or Jewish facility.)

But for now, B. has concluded, race still matters. “It certainly is an issue as our pre-integration parents begin to move into senior communities,” she said in an e-mail, “and their post-segregation children have to think this through.”

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”