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April 01, 2004

Racial Discrimination in Elder Care Facilities

by Nancy Kenyon

A recent study of residential care facilities (RCFs) indicates that 60 percent of elderly people of color experience discrimination in seeking placements. Conducted by Fair Housing of Marin, in areas of both Marin and Sonoma counties, the results showed clear evidence of differential treatment that favored Caucasian applicants.

RCFs, sometimes called board and care homes, provide living quarters as well as supervision and nonmedical care for the elderly. Typical services do not require trained medical professionals. They include assistance with bathing and dressing, supervision of medications, preparation of meals, and special services that may require additional charges. Monthly fees range between $1,600 and $5,000 per month, depending on size of the unit, level of care, and quality of the accommodations. Accommodations vary from shared rooms and baths to private threebedroom, two-bath apartments. Some RCFs utilize community resources such as social programs for the elderly, and larger facilities may offer extensive on-site activities and programs.

The audit ran from April to July 2001 and from October 2002 to March 2003. Fair Housing of Marin conducted telephone surveys of eighty of the almost 200 RCFs in the study areas and then conducted site visits at twenty locations in nine locales, which represented approximately 1,300 beds. One Caucasian and one African American tester visited each center, at different times, seeking housing on behalf of an elderly parent or in-law, medically alert and active although now alone after the death of a longtime spouse. In Marin County Fair Housing conducted five follow-up retests in facilities that indicated differential treatment in the first round. In all twenty paired tests, the African American tester visited the site first.

No blatantly discriminatory remarks were made to testers during any of the visits, no tester was told outright that people of color were not accepted, and no one was refused information about vacancies. The discriminatory treatment was subtle but trackable. In addition, the facility itself sometimes spoke volumes; for example, the residents the testers saw at the facilities all were white, and the only people of color were staff maintenance workers, nursing assistants, kitchen help, and the like.

Access and availability: Figures cited regarding available beds and waiting lists can indicate an RCF’s commitment to equal housing opportunities. At one facility, the agent told the African American tester that there was no vacancy and no waiting list, and that she was not sure when a vacancy would come up. Yet the white tester was added to the waiting list because, as the agent said, “You never know.”

At three sites, testers were given different periods of time for the wait list. Each member of one pair of testers was told during a phone call that the waiting list at a particular site was six months to a year. In person, however, the African American tester was told the wait was over a year, while the white tester again was told six months to a year. An agent at a continuing care retirement community (CCRC) told the African American tester that it would be at least a year before anything came up but told the white counterpart that the wait would be only three to six months. The African American tester was told by another CCRC that an apartment unit would not be available for a couple of years, although a studio would take less time; the Caucasian tester was told a studio would be available within six months, with a wait of only one year for a one-bedroom.

Terms and conditions: Differences in terms—including costs—quoted by the facility representative can indicate a desire to discourage the applicant. The African American tester encountered both higher monthly cost quotes and different application processes. The tester also experienced variations in the level of care offered by the facility. At two sites, the agent indicated to the African American tester that certain health conditions (e.g., incontinence) were problematic, whereas the white tester was told this would not be a problem. Shortly after the African American tester’s visit to another site where she inquired about residence for her father, who took pills to control his diabetes, the white tester visited the site claiming a father-in-law with high blood pressure and was told that people needing extensive help “like diabetes” care were not desired. In another instance, an African American tester was told that the RCF could not prepare special foods, while the white tester was told that the RCF could provide special diets.

Treatment by facility representative: The representative’s manner while speaking with and showing the applicant the facility, as well as the willingness to provide or request additional information, can sometimes encourage or discourage the applicant from pursuing residence.

One agent gave both first and last name, a brochure, and ten admissions forms to the Caucasian tester but gave the African American tester only her first name and a brochure. She refused to give the visitor application materials because the agent told the tester she was only “looking around.” At another site, the white tester was given a brochure and business card but the African American tester was given no materials at all. This same site informed both testers there were no vacancies, but the Caucasian tester was put on a waiting list and referred to additional places to look in nearby areas. Yet another agent gave the African American tester nothing but provided the white tester with a rate sheet, description of levels of care, and general information. At this site, the African American tester twice asked to see a room during the tour but the request was ignored—she saw a room only by peeking through an open door. The Caucasian tester was shown a room without asking.

Steering: Suggesting that a potential applicant look elsewhere despite the fact that the facility being viewed has openings can profoundly discourage the applicant. A representative at a life care community in Sonoma County told the African American tester the company owned several facilities, “including one in Oakland” (a predominately black community). The representative also offered information about three low-income facilities. Both testers lived in Oakland, but no other sites—low income or otherwise—were described for the Caucasian tester.

The fact that 60 percent of the sample in the initial audit revealed differential treatment is extremely serious. Furthermore, all five follow-up tests in Marin County again included incidents of differential treatment. Of the five sites chosen for testing in Sonoma County, three showed differential treatment—a consistent 60 percent.

A program of public education about the study results, along with a strong visible stance and increased enforcement against such subtle forms of discrimination, must be put into practice to eliminate racial discrimination within a population that is often vulnerable on other fronts. The following specific recommendations can help:

  • Disseminate audit results to the media and advocacy groups to educate them about the study and its findings.
  • Offer to supply or demand that the facilities supply workshops in fair housing law to the owners, managers, and agents of facilities.
  • As part of the public education effort, develop a minimum one-hour fair housing component to be included in either core certification curriculum or continuing education requirements for managers and employees of residential care facilities.
  • Take appropriate legal action where indicated.
  • Fund further systemic audits for discrimination based on race, national origin, religion, gender, and disability at residential care facilities.
  • Request that the residential care industry develop a public positive stance on fair housing. This might include small acts such as stating that “fair housing is good business and good for business” on letterhead, advertising, and brochures and other outreach materials and forms.
  • Notify state and federal agencies that license residential care facilities, as well as other watchdog groups caring for the elderly, of the findings of this report and further or related investigations.

Nancy Kenyon

Nancy Kenyon is the executive director of Fair Housing of Marin, located in San Rafael, California.