On Juneteenth, let’s start to address the separate and unequal treatment of our Black elders

“We hold these truths to be self-evident, that all men are created equal.”

As we celebrate Juneteenth, a day Black Americans around the country commemorate the end of chattel slavery in America and the promise of freedom and equality, I cannot stop thinking about the Declaration of Independence. Both the holiday and the document hold the aspiration of freedom for all and reflect most genuinely the deficiency of the American project for Black Americans.

On June 19, 1865, before Major General Gordon Granger arrived in Texas to announce the good news, the Declaration of Independence had not lived up to its proclamations.  As of June 19, 2021, 156 years after the day of Jubilee, it has yet to reconcile its deficiency. We hold this truth to be self-evident in the reality of the daily life of many Black Americans in this country.

However, it is no more pronounced than in the reality of the daily life of Black elders and Black people with disabilities who live in long-term care facilities.

What our institutions and systems allow to transpire concerning some of Black America’s most vulnerable populations, in Black nursing home residents, truly illustrate that we have not moved beyond separate and unequal. Furthermore, our systems and institutions response to COVID-19’s disparate impact on Black nursing home residents most egregiously illustrates the devaluation of Black life by American systems, institutions, and government.

The data has long showed that nursing homes are segregated, and Black residents are, in comparison to white residents, receiving substandard care. Two decades ago, research found that 66% of all Black nursing home residents lived in 10 percent of all facilities. Even with immense ‘white flight’ from nursing homes to assisted living these past two years, more recent data (2019) shows that 80% of all Black residents live in 28% of all facilities.

According to researcher Ashvin Ghandi, 19% of residents of color are not in their first-choice nursing home, despite there being open beds available in those homes. This suggests, at the very least, that the admission process needs review, and at its most nefarious conclusion, it suggests segregation in nursing homes is an intentional systemic issue.

Moreover, segregation is not the only systemic issue. Black nursing home residents are receiving separate and unequal treatment. A 2004 study, “Driven to Tiers,” showed that residents of color were more than four times as likely to reside in a nursing home with historically poor performance than were white residents. Black nursing home residents were more likely to be admitted to a nursing home with 44% more deficiencies, and more likely to reside in a nursing home cited by surveyors as having a deficiency that caused “actual harm” to one or more of their residents.

A 2019 report suggests not much has changed, as Black American residents still resided in nursing facilities that had worse performance relating to rehospitalization, successful discharge into the community, and the star rating indicator.

Poor performance and actual harm mean Black elders and Black people with disabilities are more likely to have untreated persistent pain.

You may ask what does poor performance or “actual harm” deficiencies mean as it relates to Black life. It means Black nursing home residents have a 50% higher risk of being rehospitalized than their white counterparts. Additionally, Black nursing home residents are more likely to be rehospitalized while residing in a nursing home for conditions associated with not receiving proper care. These conditions include dehydration, poor nutrition, and severe bedsores.

Poor performance and “actual harm” mean Black elders and Black people with disabilities are more likely to have untreated persistent pain and are more likely to be subjected to physical restraints. Lastly, in the context of COVID-19, poor performance and “actual harm” meant more Black death.

University of Chicago researcher, R. Tamara Konetzka found that nursing homes with the highest percentage of non-white residents were twice as likely to have Coronavirus cases and deaths.  A Washington Post data analysis of data compiled by Brown University covering 11,000 nursing homes (three quarters of the nursing homes in the US) found that death rates increased as the number of Black residents increased.

These facts are appalling, but what is more horrific, and yet revelatory, is our systems, institution, and government response to these long known disturbing facts. In Taylor v. White, a 1990 class action lawsuit against the Pennsylvania Departments of Health and Human Services, plaintiffs alleged that Medicaid recipients and people of color were subjected to discrimination both on the basis of payer source and that the nursing homes in Pennsylvania reflected unlawful segregation of residents based on race. The lawsuit was informally settled (without written agreement) and dismissed by the courts without prejudice because of the informal nature of the settlement. Yet, little has changed.

Because wealth accumulation is tied to systemic racial discrimination, many Black residents continue to pay for their care with Medicaid. Medicaid rates are below private pay rates and are generally below actual costs of care. Thus, Medicaid rates may directly affect quality of care for Black nursing home residents. Again, this was known by our institutions, legislators, and policy makers in decades ago and yet Medicaid rates have not increased.

Black Americans can no longer suffer the lie of equality while facing squarely the reality of its failed execution.

With the backdrop of the nursing home tragedy in mind, I think back to the hopes of the enslaved Black Texans as they heard the good news. Today, I celebrate Jubilee Day in their honor with great expectation.

It is past time that this country and its institutions and systems live up to our forefathers’ proclamations and high ideals. Black Americans can no longer suffer the lie of equality while facing squarely the reality of its failed execution.

America can start to live up to its projected values and honor the hopes of Black ancestors and the fiber of Juneteenth by addressing its neglect of Black elders and Black people with disabilities.