Equality of Care: Treating Nursing Home Residents of Color

Why are nursing home residents of color getting worse care? Many face unequal treatment and neglect. In this week’s episode, nursing home abuse attorney Rob Schenk welcomes guest Dr. McAdams-Jones to talk about the challenges and solutions for ensuring equal care for all residents.

Schenk: 

Treating nursing home residents of color stick around.

Hello out there. Welcome back to the nursing home abuse podcast. My name is Rob. I’m going to be your host for this particular episode. In this episode, we are, we’re going to touch an important topic and that is how the nursing home population that is melanated versus non melanated or treated, why there is a difference and what can we do as a nursing home industry or as family members of loved ones in a nursing home to course correct on that.

Again we’re not talking about this subject alone. We have an expert in the field and that is Dr. Diane McAdams Jones. Dr. McAdams Jones has practiced nursing. For 50 years, 45 of those in hospitals, coupled with education, she is a prior military nurse and has served as a staff nurse manager, and educator.

And she is a wonderful human being. And I really enjoy talking to her. Dr. McAdams Jones. Welcome to the show. Oh, thank you. People that are, there’s not very many of them, but some people listen week after week, and they’re going to recognize your name as having been on the show before, but this week, I wanted to talk about the care in a long term care setting for people of color, and in my experience, and that’s why I want to have you on here, I’m a middle aged white guy, but in my experience of taking these cases on, there seems to be a real deficit.

Learn more about Dr. Diane McAdams Jones here.

• Visit Just Us Socializing to discover her advocacy efforts, which include providing bias awareness training online and in-person for law enforcement, other agencies, healthcare professionals, organizations, and the general public. These trainings cover important topics such as bias, race, space, and cumulative social disadvantage.

What Is the Root Cause of the Deficit in Nursing Home Care for Residents of Color?

In the type of care, whether it’s intentional or unintentional whether it’s systemic or not systemic, there seems to be a deficit between the way people of color are treated in nursing homes top to bottom versus people that are not. I just wanted to, I wanted to put that out there. You, we could take this in whatever direction you want, but what are some of the primary ways that you see care for residents?

They’re of color versus none for you, what are you, what’s your take on that? 

Dr. McAdams-Jones: 

So here’s what we’re going to do. We’re going to use terms like melanated and non melanated. 

Schenk: 

All right. All right. 

Dr. McAdams-Jones: 

You are non melanated. I’m a bit non melanated, but more melanated than you. And the more melanated you get, that means the more color you have in your skin.

I like to use those terms because I don’t like to offend people because some people don’t like to be called white anymore. Used to be famous and preferred to be called white. Things change and times change. Some folk will say, call it like it is. It is like I’m calling it. Some folk don’t like to be recognized as white except when they go in for a mortgage or if they’re going in for care.

As you mentioned, skin color matters. So today, what I’d like to do is give some historical context. About skin and how it is viewed and why it is important. I like to talk about who’s seeing our skin and why that’s important. And then finally, I would like to provide some helpful resources to support people and give you more information.

Explore the racial disparities in pain management here.

And talk about what I’ve shared. I also say, I am a nurse. I have been a nurse for over 50 years. I was in the military. I understand health care from a lot of different care points. Also, I was born in the South and I was a sharecropper’s daughter, so I have stories and those might infuse some of the things that I say.

Now, historical context, this is not to disparage anyone, but instead, I want to situate what I’m going to share in some cognitive context. Access to medicine and health care has not always been easy for some people. And today for many, it still isn’t easy. Poverty has its own culture. It affects everyone.

Not everyone feels that healthcare is a right. And you have to understand that a lot of folks feel it’s a privilege. So let’s not forget the not so great care and lack of care when we speak of Africans, black and brown people concerning health care. History tells us that medical experimentation on African Americans was rather brutal.

And history connects that to unequal medical care for black and brown people. And that still goes on today, according to the NIH and other literature. I pulled from an article by Hoffman, Trey Walter, Axe, that’s spelled A X T and Oliver. Black patients continue to receive less pain medication for broken bones and cancer.

Black children receive less pain medication than white children for appendicitis. One reason for this is that many people still associate and inaccurately believe that blacks literally have thicker skin than whites and they don’t. Experience as much pain, not true. So I know that colorism and racist views about skin color have traveled over to brown people as well.

And this is why we need to talk about melanin. And non melanated people, because that means skin color matters. The translation is literally skin color matters. Although the intent to be kind and considerate is very much appreciated, but the phrase, I don’t see color in many ways. Not seeing color can be a big mistake.

For further reading on racial discrimination in elder care facilities, check Racial Discrimination in Elder Care Facilities.

Color does matter, particularly in health care. To put it mildly, an article in the New York Times, and I’ll credit that to Sarah Beth Maney, but she quotes Dr. Jenna Lester, J E N A Lester, L E S T E R, This doctor is the director of the skin of color program at the University of California, San Francisco.

If you’re only trained, she says, to look at something in one color, you won’t recognize it in another color. So when you look at melanated and non melanated skin and haven’t been in health care for over 50 something years, I’m going to tell you that’s 99 and 44 100 percent true. Very true on skin tones and colors.

Learn about clinical signs in different skin colors at Mind the Gap: A handbook of clinical signs in Black and Brown skin.

presentation of skin diseases and just plain illnesses in general. They don’t appear the same when the color of the skin is in different shades and tones. So two terms or examples I do want to offer that are pertinent to skin color and health care. I can give you many, I’m not going to do that because I’ll only confuse you.

What I want to say to you is there’s two terms here and all of us can benefit from understanding how this is important. The first one is cyanosis. In healthcare, this term has to do with your skin. It’s the color of it. Your skin, your lips, or your nails. They turn blue due to a lack of oxygen in your blood.

And if you have darker, more melanated skin, cyanosis may be easier to see. If you open your mouth and look inside the person’s mouth, look at their lips, their gums, the buccal mucosa, their nail beds. That’s hard on a lot of us. Agendered because people paint their nails. So the ear lobes you could do, but definitely the gums and inside the mouth.

Check out this feature from the Washington Post on skin color and medical diagnosis.

So now why is that important? If you’re at home and a loved one has darker or more melanated skin tones. And they don’t look right, or they just look ill, and sometimes you’ve looked at people and you thought, something doesn’t look too good. You can better ascertain their need for oxygen by checking the areas I just talked about.

The other color, or word, term I want to use is pallor. P A L O R. That refers to the pale appearance of the skin due to reduced oxygenation. Same thing. This could occur in anemia or shock. Now having this be a podcast with visuals I probably could have put some pictures up here, but that’s not confusing.

For advocacy and rights in nursing homes, visit National Consumer Voice.

Schenk: No, I was going to say that’s okay. As we discussed, most of the people that consume this podcast listen. 

Dr. McAdams-Jones: 

Okay. 

Schenk: 

All right. So that’s good.

What Are Some Ways That Care for Nursing Home Residents of Color Differs from Others?

Dr. McAdams-Jones: 

So we’re talking about why we should be concerned? First everyone should be concerned regardless of the level of melanin in your scan. So let me explain.

Healthcare professionals are not the only ones who will see your scan. So you say then who? All right. In America, we pronounce M A S E U S E as Masseuse. The actual pronunciation I think is Masseuse. And that is a female who practices massage. And then Masua is the male who practices massage. Ask yourself, do they see your skin?

Yeah, you’re dang tootin they see your skin. If you’ve ever had a massage, you take your clothes off, down to your waist, and you’re laying down and they’re rubbin all over you. So they see your skin. Do you think they get any education about skin? I would suggest that they probably do. How much, I don’t know because I’ve not gone to school with them, but I would imagine they do.

Now, they’re not going to diagnose, but I think it’s important for you to say to them, if you see anything that doesn’t look right or normal, let me know. And then that’s in your hands. You go home, you get a mirror, you look at your skin, look at your back, look at wherever they are massaged and see what and go to a dermatologist so you can get some more understanding.

Check out The Impact of Racial Disparity on Nursing Home Care

All right. Nail technicians, males and females go to nail technicians. I’ve been in nail spas and I see men, women, everybody in there. Why is that important? Because they likely also discuss skin and skin conditions. in their educational spaces. So why is that important? It’s important because when you are in a nail spa, they’re looking at your nails.

They can see things that might not look right. What you probably should do is say if you see anything that doesn’t look right around my cuticles or my nail beds, let me know. And you can see yourself when things on your nail beds don’t look good or don’t look right. They should really be clear. Dark lines, dark spaces, dark cuticles.

If you don’t normally have dark cuticles. That’s an issue. And I might say, if you’re one who goes to a nail spa frequently, like every two weeks, some people go more often, maybe it wouldn’t be a bad idea to take a break for a week and let your nails breathe. They don’t breathe very well through that gel.

Just saying. Ask yourself, who do you see more frequently? Your healthcare provider? Your masseurs? Or your nail technician? I guarantee you, most people are going to say their masseurs. Are they going to say they’re a nail technician? Isn’t that a thing to think about? You see them more than you see your healthcare provider.

Learn more about Addressing Emotions in Nursing Home Life.

Can you be asking the questions that I just said to ask if you’re going to a nursing home or rehab facility often they have the hair care salons in a lot of these Nursing homes, I don’t like to say nursing homes. I like to say more about a rehab center. I got away from nursing homes because these centers have more people inside getting care than just the elderly folk.

When I say nursing home, people start thinking of old elderly people. I don’t like to use the term old or elderly people, but however, many folk are in rehab facilities. Turned nursing homes. Now to recuperate and sometimes they live there because they cannot live outside. But the point is, there are hair salons.

There are also nail salons there. If your loved 1 is going and partaking, then you could have some discussions with them about what they are seeing in your family members head. What are they seeing on your family members’ nails? Because you won’t be the one seeing that if you are not caring for their nails.

Now, let’s say you’re in a facility where there aren’t nail care salons and there are no hair salons and you’re taking your loved one out in the same conversation with the care providers. If you’re the one doing it, then the conversation is for you to look at their nail beds. Just because a person is elderly or incapacitated does not mean every part of their body falls apart and it’s normal.

So I don’t like that term. You’re of age. It’s normal. No, it ain’t normal anymore for a person over 60 to lose their urine and have leaks in their pants. Then it is for someone who is elderly to have lines on their nails, dark lines on nails or dark cuticles because of age. That is not the case.

So this is why we’re having the conversation. You need to have a conversation with somebody if you’re seeing things like this, that don’t look normal to you, or they don’t look clear. It does not look like it. The nails that you would expect to see are the nails that you saw in your family member before.

For legal assistance related to emotional abuse in nursing homes, visit Georgia Nursing Home Emotional Abuse Lawyer.

Yeah, baselines are always good. So if you don’t have a baseline, now’s a good time to get a baseline. Next time you’re with your loved one at one of these facilities, make sure you check their nails, check their toenails because their feet are more sometimes important than hands because hands are out there and people see them but you don’t see the feet.

You’ve had the diabetic teaching. I would imagine if your loved one has diabetes, we know we have to pay attention to the feet. But if they don’t, then you may not be looking at the feet. My point is to look at the feet. If they are darker skinned and more melanated, and this is for other folk who are looking, check the bottoms of the feet of your patients.

Dark spots on people who have dark skin don’t have to be normal. If they’ve not had that dark spot before, then it’s not normal. This is off normal, off the chart, and you need to have it checked because cancer, it just appears in strange places. And it looks like, oh, it’s just a dark spot. When you’re older, people get dark spots.

Learn more about Four Things to Do If You Suspect Neglect or Abuse

That’s true. Older people do get dark spots, but that doesn’t mean that they are just perfectly humming along naturally dark spots. They are not always that the case. So that’s why you need to have, as I said, a baseline. So if you don’t have a baseline for what the skin looks like on your loved one, now’s the time to get a baseline because you’re talking about.

normal for that person versus what’s off normal. And when we’re in these homes as nurses, we do skin checks, but let me tell you the skin checks I’ve done, I’ve written information down. I don’t have that information in my brain. So I’m not thinking about it every day. And so when I see you come visit your loved one, I’m not thinking about what I might’ve seen on the skin, but I charted it is in the chart and the provider will see it when they come to see the patient.

Your loved one. And I see you have a point because I saw your head. 

What Are Some Things You Suggest Families Know About Caring for Nursing Home Residents of Color?

Schenk: Yeah. You can see that my brain is starting to smoke. So I guess I got an idea that when I get out, I have a question. Okay. So I understand you got cyanosis, you have other aspects in which the melanated versus non melanated people, the assessments will be different.

What you’re looking for will be different. I get that. So what’s your experience in terms of like, how well is this knowledge being trained or being provided to the long term care staff, the rehab facility staff? Because probably to a certain percentage of the staff who are non melanated, that’s not intuitive.

We, the typical non melanated person growing up, don’t know that most people that are melanated might. Go to sleep with a do right. For example, that’s something that I learned maybe five years ago and I’m 46 years old. Okay. So you have a certain amount of staff that it’s not intuitive what to look for because they don’t see it very often in their own experience.

And that’s sad, but that’s typically how it is. And you have the other percentage. They might see it, but they’re not trained on it. So what can we do as a nursing industry to train the people on exactly what you’re saying? 

Dr. McAdams-Jones: 

Back to what Dr. Jill Lassiter said, you just reiterated, you keep seeing it in one color all the time.

Of course you ain’t going to recognize it when you see it in another color, cause you don’t see it. And you’re going back to the contextual piece I started out with. It’s the fact that the dominant sees the dominant. It doesn’t take time to see the non dominant. This is why people who are non dominant have to have a voice and you must arm yourself with knowledge when you’re speaking as well, because the first thing that’s going, you’re going to be hit with is some technical term or some lack of knowledge that is perceived you have a lack of knowledge.

This is why I’m saying you arm yourself. So that’s what we’re doing. Thank you for doing this podcast because that’s what we’re doing. We’re arming ourselves with knowledge. There’s so much. I do in this relational space about color and colorism. Now, you want to know, what do you do? You keep beating people up with this.

And you keep sitting there with your brain smoking and you figure out other ways we can use a podcast like this Other mechanisms to tell people back to dr. Lassa Jenna, she said that’s the problem when you’re in schools Nobody teaches you about how this is going to appear with somebody that’s off color Unless of course you are of color or you are melanated.

Learn more about Who Can You Sue for Nursing Home Neglect?

That’s when you start thinking about it. So we’re gonna go there. All right, we’re just talking about who’s seeing your skin more importantly and more frequently than somebody else. And I’m saying that because I’m trying to spill out to the world. Hey, out there know what we’re talking about here.

These are the skinny minute conversations and we’re going to talk about people like the Cleveland clinic, what you can do to educate yourself. The Cleveland Clinic is a good place. The Mayo Clinic is a good place. The American Academy of Dermatology. That’s another good place where you can go and look and read and you can pretty much count 99 and 44 100 percent of the time the information you get is going to be accurate and you need to be arming yourself with information and asking questions and when you ask questions, if you don’t ask questions, you don’t get answers and the more we ask questions, and the more we arm us ourselves, we can dismantle some of the.

I want to use this term now and deviate and I said, I wasn’t going to use it, but white supremacy, which has set up a lot of our educational spaces. Has set up a lot of our systemic issues, has set up our justice system. So much goes on. And when you are a minority, there are no culprits because this has been happening for so long.

It’s like the oxygen you breathe. They don’t see it as having been a miscarriage of care for someone or a miscarriage of justice or mischaracterization of someone. It’s not seen that way. And I see you shaking your head, sir, because any person who has gone to any law school worth its salt, you know all of this.

You get taught about all of this. 

Schenk: 

And just to interject because people listen to this, I’m shaking my head and affirming not an objection to what you’re saying. 

Dr. McAdams-Jones: 

No, that’s why you know, that’s why I said it because you’re shaking your head because you’re taught this in law school, you’re taught about critical race theory.

You’re taught about systemic injustices. I didn’t even bring up the fact that we will use bodies back in the early, late 18, early 19th century. It was just a normal thing to go get bodies out of the ground as soon as they had passed away. Medical students were doing it. They were getting the bodies out of the ground and they were doing all the research on them aside.

From the fact that Dr Sims was the father of gynecology was doing all the experiments on the African women without any anesthesia, which led into the fact that people believe black people do not have pain. But the fact of the matter is, if you’re a minority, those bodies being taken out of the ground weren’t just the black bodies, it was the poor people too.

There were white bodies as well. Sometimes wealthy white people were pulled out of the ground. It was just wherever they could find a fresh body. And this is why people guarded their graves for so many days after their loved ones passed. But who could have paid to have theirs guarded? Poor people. No matter what color you are buried on the outskirts of town.

So all of this has to do with who you are, a term I don’t like to use but race. It has to do with who you are, where your position is in society, and how the society has been structured around you. So it’s structured to teach. In books about scan and what kind of even examples do we show white people scan this happened back in.

It was really important and made a little bit of history. It was in newspapers was cobit toes. A lot of teenagers start showing up with these swollen sort of red toes, but. In white kids, you could see it was swollen and red and, but in black children, you couldn’t really and brown children. You really honestly could not see that.

It had the same appearance as a white toe. So it was more difficult to get a diagnosis, right? Because of skin color, we are getting more people who are interested in this in health care. And more people of color who are interested and the more information we get, the better it will be for all of us, because then we will have the data and the product as well as the knowledge that we need to recognize and to treat.

Learn more about Overlooked Signs of Nursing Home Neglect

But how do you get it out there? You keep having podcasts like this. I keep teaching about it. I teach my students about it. Those of you under the sound of my voice spread the word. Go out to the American Academy of Dermatology read. They are trying to make a difference and go to Dr Janice page out on the San Francisco color.

I think she’s called the skin of color program at University of California, San Francisco. Her name is Dr Jenna Lester. J E N A L E S T E R. And if you are a young person interested in health care, hey, this is a good place for you. Try to go into something that has to do with dermatology. And other than the spaces, I just say it to you about reading.

Some of us don’t like to read a lot. So that’s why I suggest going to the American Academy of dermatology web page. You can find a lot there and they update it fairly regularly. The Cleveland clinic, the Mayo clinic, those are reputable, credible sites. I want to also talk to you about the handbook of clinical signs in black and brown scan.

I am going to spell the authors. Last name because I will murder it if I try to enunciate it’s M. U. K. W. E. N. D. E. I think it’s McQuinney. The other person is T. A. M. O. N. V. I have no idea because that is out there. I don’t know what it does. And then Turner T. U. R. N. E. R. The title of the book is Mind the Gap between black and brown skin.

It’s a handbook of clinical signs of black and brown skin. You can download it. You don’t even have to buy it. You go out there. You just download it. I downloaded it on my computer. And read it. The reason why I didn’t mention all the names of diseases there, because half of them, they’re very difficult to pronounce.

If I pronounce them, you would never get the spelling by how I enunciate and pronounce it. But if you get that book, if you download it again, a handbook of clinical signs in black and brown scan, and it’s by M. U. K. W. E. N. D. E. T. A. M. O. N. V. and T. U. R. N. E. R. Mind the gap, black and brown skin. It’s just a starter, but it shows you so many pictures of what it looks like when it’s on brown skin.

And here’s what it looks like on white skin. And if you are not trained to recognize. How to see when something doesn’t look right on skin, particularly other kinds of skin that is melanated, you won’t recognize it. And with issues of skin, like a lot of issues, you want to nip them in the bud. You do not wish to leave them there because oftentimes, the worst ones, they don’t hurt.

Learn more about Nursing Home Race Disparities.

A lot of cancers. They don’t hurt. That’s why we don’t find them. Some of them don’t start giving you science about lung cancer. By the time you get a call, I hate to say this. It’s getting a little late ovarian cancer. By the time you start having the pain and seeing blood, it’s just late. And this is the problem with cancers.

They don’t walk up and shake your hands and say, hello, I’m cancer. So you have to pay attention with the scan. You see anything that doesn’t look right. You have to call someone’s attention to it. And if you call it, you are the nursing assistant of a family member in these homes and you are calling the attention of the healthcare provider and they’re not listening, raise your hand.

and say, please hear me now. This is of concern to me. And when you’re saying these things, write down the date, write down what you said and keep a record. When I say this, and anybody that’s in health care hears me say this, yes, people write things down. Not only that, they videotape you with the cell phone in the hospital.

So when somebody tells you something, and you’re in a nursing home, don’t think about it. It’s just a nursing home and he’s just an old person because it doesn’t work that way because people have phones and they videotape and they write things down as they should. Because if they present an issue to you, you should take care of it.

Now, if you’re the health care provider, you thank them and you let them know you’re going to report it and do so and write it in your notes that you. Picked up this information from the family member and you wrote it in your nursing note that I reported it to my next person in charge, which might be my charge nurse.

Or if I’m the nurse, then it’s my health care provider. I reported it. Healthcare providers need to take note the same way. This was reported to me and I did ABCD, blah, blah, blah, and follow up on it. It’s a lot. But if you don’t, this is how you get caught in a lawsuit. Is somebody let a piece of the puzzle drop or they forgot it?

I see your head smoking again. 

Schenk: 

That’s very true. That is absolutely true. That’s how a lot of lawsuits start and the lack of documentation and which represents oftentimes the lack of care. But Dr. McAdams Jones, you gave us a lot of food for thought today. And I learned about the difference between Monsieur and Monsieur.

I really appreciate that. That’s a good lesson. And I guess French. I never knew that was the difference between the two. But once again, thank you so much for coming on the show and talking about this topic, which is extremely important and now in the show notes, I will have a link to that, the handbook that you mentioned.

And so I would really highly recommend everybody to go check that out. But once again, thank you so much. 

Dr. McAdams-Jones: 

Thanks for having me. 

Schenk: 

All right, thank you. Folks, I hope that you found this episode entertaining and educational, and maybe you learned a little bit about linguistics. I know that I did.

I got a little bit off. A little bit of French lesson there. New episodes of the Nursing Home Abuse podcast debut every Monday, wherever you get your podcasts from. You can also watch this online on YouTube or on the website, nursing home abuse podcast.com. And with that folks. We’ll see you next time.

Guest Info:

• For further details about her academic and professional background, visit her profile at Utah Valley University.

• For more information about Utah Valley University and its programs, visit Utah Valley University.
• Stay updated with Utah Valley University’s latest news on their social media: @utah.valley.university