Racism, sexism, inappropriate sexual comments/advances and bias are complex topics that can create deeply emotional conversations. Our focus in this post is twofold: (1) to provide a son or daughter some tips to use when talking to parents or loved ones about these issues, specifically as it relates to receiving care and (2) to share Silver Lining Home Healthcare’s handling and stance on discriminatory behavior.  As health care professionals, we run into situations all the time where a daughter or son is embarrassed about a parent’s racist tendencies, inappropriate sexual comments towards caregivers, and numerous other behaviors that may invoke feelings of shame. These topics are hard to handle. Know that you are not alone.

*This article is not meant to be inclusive of all good tips. We encourage you to research more on the topic and be prepared to engage using the specifics from your situation, including your own experiences and that of your parents/loved ones.

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TALKING TIPS

As a healthcare worker, I’ve see racism, sexism and cultural bias first hand. I know we all have inherent bias built into our psyche because of the way our society has developed. The idea that not everyone is equal exists in the world, even if we don’t want to talk about it. So let’s dive into some practical ways to approach these important–albeit difficult–conversations with our loved ones. Don’t get frustrated because your parents’ long-held beliefs don’t change overnight. Like many difficult conversations, these will probably be ongoing. Planting seeds and watering them (excuse the cliche) may be the best approach to nurture a shift in beliefs and behavior.

Ask & Listen. Ask genuine, open-ended questions about their life in regards to stereotypes and biases that exist, and how your parents treated these topics. A few suggestions are:

• “You’ve mentioned several times that you don’t want [insert what they’re objecting to]. Tell me more about why.”
• “What experiences have led you to believe [insert belief]?”
• “When you make an inappropriate comment like that, do you feel it is warranted? How would you feel if someone said that to me?”

Be aware of your own prejudices: How do you react when you hear terms like “Jewish”, “Muslim”, “African-American”, “Person of Color”?  What do you think of when you think of someone who is uneducated, poor, or of the LGBT community? How do you feel when someone different than you expresses a different religious opinion? Do you feel defensive? Open-minded? Understanding? Without being aware of your own prejudices, it may be difficult to address them with your loved ones constructively.

Educate. In order to educate someone else, educate yourself. Perhaps you know the key terms when it comes to the topic of discrimination, but a refresher never hurts. Click the terms below for  their definition:

PREJUDICE  | BIAS | STEREOTYPE | RACISM

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HANDLING OBJECTIONS

Prepare for objections. Prepare for some defensiveness. Keep in mind that you may be addressing lifelong beliefs that are considered by your loved one to be truths. Below are some common objections you may hear. Rehearse the best responses so you feel confident in engaging your loved one in a conversation.

Objection: “They’re not trustworthy.”

Best response: “Tell me more about what you don’t trust. Is there something in the house you’re concerned about protecting from strangers? Is there something that has made you feel unsafe?”

It may help to provide some education around the process of hiring for healthcare workers. All healthcare workers are hired using the same criteria. While this differs by state, typical requirements (and the requirements in Delaware) include a background check, fingerprinting, having an adult abuse check and a child abuse check, and completing a motor vehicle record check, as well as a drug screen.

Objection: “They’re uneducated.”

Best response: “What is your goal with education? What is the level of education that you would like to see?”

Education is often standardized for license levels. For a Certified Nursing Assistant, a program consisting of 160 hours plus a final exam is required. For LPN’s and RN’s, the completion of a licensed/accredited nursing school (with passing grades) is required prior to taking the NCLEX.

Objection: “They’re not like me.”

Best response: “Nobody is! Skin color, sexual preferences or religious preferences doesn’t change that. We’re all completely unique. Your uniqueness is why I love you!”

Objection: And sometimes, there may not be a specific reason, it’s just “No way!”

Best response: “What is the biggest reason you don’t want people taking care of you?”

Fear is a big motivator. Care may not be wanted at all, and reasons such as sexism and racism are excuses. The requirement of needing care often brings along feelings of lost independence. At Silver Lining Home Healthcare, we actually focus on care that keeps people independent, not measures that take away independence. But it’s crucial to understand that physical and mental changes, the necessity of having someone assist with IADLs and ADLs, and the emotional state of your parents play a big role in not wanting or accepting care. See more on getting your parents to accept help here.

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HAVE A CONVERSATION WITH YOUR HEALTHCARE COMPANY

Talk to your healthcare company about your situation. Sometimes behaviors and comments are part of a disease process; caregivers can help you understand that. You will also gain an understanding about the boundaries your healthcare company has in place to handle discrimination as it relates to providing care. Ultimately, boundaries are created around what is safe, what is required for a healthcare worker to do his/her job effectively, and what is appropriate based on the situation and disease process.

Safety. If the safety of a healthcare worker is ever in question, discriminatory behavior or comments is never appropriate. Physical aggression in a competent individual (someone who can make decisions for him/herself) will never be tolerated.

Hostile workplace. Boundaries are put in place to ensure that all healthcare workers can do his/her job. Conduct and speech typically considered “hostile” is intimidating, offensive, abusive, mocking, and may reach the level of harassment. Typically, we consider it hostile if any of the above occur AND it is intentional, severe, recurring and/or pervasive. Thus, it’s important to discuss other factors (such as disease) and how they relate to “intentional”. So who decides this? A particular healthcare worker may have a different perception of the situation. Typically, the behavior is viewed how a “reasonable person” would characterize it.  It must be considered “crossing the line” not only on a subjective basis by the person making the complaint, but also on an objective basis by “reasonable people.”

Disease-specific considerations.  Different diagnoses result in different mental and physical manifestations that affect behavior. The easiest one to talk about is dementia. Dementia may make a person say or do things he/she wouldn’t do otherwise. Silver Lining Home Healthcare specializes in dealing with difficult behaviors, and our caregivers and team understand how to appropriately handle difficult situations. If they are in a difficult position or feel uncomfortable, we immediately address it.

• The difference between competence and incompetence in this context is important. Read more about that here.
• Understand that even if a parent has severe dementia as the reason for inappropriate behavior, it may still affect a healthcare worker’s ability to provide effective care, even though it doesn’t qualify as a hostile work environment.
• Effective Communication – Talk about the difference between agreement and respect. I don’t have to agree with you to respect you as a human being. And just because you have the right to say something doesn’t mean it’s the right thing to say. As the son/daughter, attorney-in-fact, or decision maker, it is crucial you are willing to have these conversations with your loved one and abide by the boundaries yourself.

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WHAT IF…

So here’s a question you may have: “What if my dad openly acknowledges his homophobic or racist beliefs and claims his right to express them? Will you still take care of him?”

Answer: We love being able to have conversations around why our care is excellent and we’ll set appropriate boundaries. At no point will we tolerate inappropriate behavior or a hostile work environment for our employees. We won’t discriminate or change our care to accommodate your dad’s discriminatory preferences, so if he is unable to accept the amazing people we send in, then it will be a choice you and he need to discuss. You may be amazed at how acknowledging your dad’s feelings allows him the space to accept help from us and starts changing his perception. We’ve had many times when a favorite caregiver turned out to be someone the client would never have picked themselves.

Know that discrimination in the workplace is illegal and demoralizing. As an employer, we have a high purpose of caring for our people. We also acknowledge that we’re not going to change everyone’s mind. Whether it’s because of a deeply held conviction or because of a disease process, there may not be enough educational conversations in the world to influence a complete change in beliefs. Often, the conversations will be about setting boundaries and defining appropriate behavior. We don’t need everyone to change their beliefs in order to receive care; we do expect all clients and families to treat people with dignity and respect. Healthcare workers care for anyone and everyone regardless of skin type, sexual preferences, religious orientation, background etc. A healthcare company is responsible for giving you a qualified and competent person that can provide the care required. If the issue of requesting specific caregivers based on race or religion is a requirement for you, then Silver Lining Home Healthcare will not be the best company for your needs. If you want the best, customized care by expert Certified Nursing Assistants, Licensed Practical Nurses and Registered Nurses, we’re your people.

Additional Reading:

How Do We Talk To Our Elderly Parents About Race?
Talking About Race and Racism
Why It’s So Hard to Talk to White People About Racism
When Does a Workplace Qualify as Being Hostile?