Thursday, June 01, 2017

The White Privilege of "Independent Living"? Stepping into it.

Nursing Care, Home Care, Assisted Living, Independent Living
First, let me say that I am bias.
I do not believe that the elderly should be removed from society in anyway.
It diminishes the input of wisdom that comes with age.
It glorifies only being young, and/or privileged.

Next, let me say, that this is an issue that is something I think about, but have no answers for.

This topic continues to return to me.
Is it possible that Independent and Assisted Living is really just a "White privilege" ?

My mother lives in a beautiful independent living facility.
Really, it is amazing and she is well cared for. For her, it is exactly what she desires and I would never deprive her of her choice.

As I walk with her it comes to my attention that there is only one color in those rooms
There is only one status in the building
Middle Upper Class wealth.
Here is an entire group of, mostly professional, people
who worked their way up,
or inherited their way there,
but was that "on the back" of the minorities?

Is this actually the exact same thing we have seen for years with the public school systems.
White sections of a city keeping the minorities in their place by offering them schools, but at a lesser extent.
Separate but equal. Pay more taxes and you get better- but it is still equal. Right?

In old age it is worse. Nursing homes, and what they imply, are quickly being abandoned by the privileged class and being filled by the minority, working class. The middle uppers are moving into the cool Independent Living places. "We"save for it. Buy insurance for it. Deserve it.

An example of the expanding supply of alternatives to nursing homes is the rapid growth of assisted living facilities. However, these facilities cater primarily to relatively well-to-do people with private health insurance, and they tend to be concentrated in areas whose populations have high levels of education, income, and wealth in the form of equity in the value of personally owned housing.8 Such areas are typically suburban and predominantly inhabited by whites.

Growth of Racial and Ethnic Minorities of US Nursing Homes

For, as we see the growth in the predominately white Independent Living centers, we see the equal amount of growth in "Nursing Homes" for minority

I "see" lots of privileged white people who rail against how their minority members are cared for. They are willing to spend more of the working people's money on more education (while moving to lower property tax states or out of the country all together).  They insist on higher pay for all, but rarely shop in the stores or eat in the places that "those" people work in. In fact they are hell bent on keeping "big box" stores out-- especially Walmart---but spend the majority of their money on Amazon while the poor pay extraordinarily high prices at little mom and pop stores in their neighborhoods (instead of foods at those big box stores at a reasonable price). They are upset about illegal immigration, but rarely think about the exploitation of the migrant working --even in their own houses or gardens.  

Something just does not ring true to this plight.  

I do not have an answer, even one. I just am beginning to ask the questions. 
Isn't that where social justice really starts?
My Jesuit upbringing  taught me to think of such things, even when I see that my teachers in those schools retire to beautiful San Francisco hills to be cared for, in the way they are accustom, for the rest of their natural lives. 

The ultimate, do what I say and not what I do?


Bonnie said...

I agree with your assessment, there is a gap. I feel it has more to do with the breakdown of the extended family, where elderly were cared for in the home of relatives.

I studied Healthcare Admin and there is a reason for Independent Living (healthcare term is assisted living) vs. Skilled Nursing Facilities, and it has to do with Activities of Daily Living (ADLs) and insurance payments.

AL's provide housing, meals, laundry, cleaning. Most other services, such as transportation, medicine administration, bathing assistance, meal assistance require additional fees or expenditures. AL is not covered by Medicare or Medicaid, although some additional services, such as an aide, may be covered under Medicare. ALs are therefore typically paid for with private funds or long term care insurance and the person's social security and/or pensions.

SNFs are used when the individual can no longer perform some of the ADLs. SNFs are covered by Medicare, to some extent, and Medicaid, and typically personal funds are "spun down" to qualify under Medicare/Medicaid. The SNF balances the number of private pay vs Medicare in order to be profitable.

There are other levels of care and carve outs for rehab,
alzheimers, etc. (see: but in my mind it all comes down to what the facility can get paid for and still be profitable.

Practical Parsimony said...

Great post! I will end up in a nursing home! I am well-educated, privileged, but without money to afford the fancy assisted living places.

Janette said...

So will I. My privilege does not get one too far if you don't have money ....