By Robert Espinoza and Jean C. Accius
In early April, as the COVID-19 crisis spread across the world, two notable developments took hold. First, the United States became the pandemic’s epicenter, reporting more confirmed cases and deaths than in any other nation. Second, it became clear that black and Latino people in the United States were being hospitalized and dying from the virus at disproportionate rates.
Given that older adults and people with serious medical conditions are at greatest risk of COVID-19 complications, this raises pressing questions. What are we doing to support older people of color, who might be disproportionately impacted by this outbreak? And why does COVID-19 disproportionately impact the health of older people of color and their paid caregivers, their direct care workers?
What follows are seven racial equity strategies that government agencies and aging services leaders can immediately employ to support these populations.
Racial Inequality Often Determines Who Survives COVID-19
New data have revealed the profound disparities in COVID-19 infections and deaths among black and Latino people in areas hit hard by the coronavirus. Sadly, these disparities are not random, but reflect a long history of inequality wherein social, economic and political opportunities were extended to some at the expense of others.
People of color face significant structural barriers to healthcare access, from living in communities with inadequate healthcare resources to dealing with racial bias in encounters with healthcare providers—and more. While the Affordable Care Act has caused an increase in health coverage for all groups, the uninsured rate remains higher in communities of color. Race then serves as a social determinant of health status, leading to high rates of diabetes, heart disease, asthma and other conditions that put people of color at heightened risk from COVID-19.
By the time people of color reach older age, a lifetime of discrimination has accumulated, harming their physical, emotional and economic well-being. In addition, they now face a variety of aging-related vulnerabilities tied to economic insecurity, social isolation, physical and cognitive decline and widespread ageism, among others.
Aging services also are saddled by the racial inequality that marks America’s COVID-19 crisis, as this sector disproportionately employs and serves people of color. Direct care workers, for instance, are a predominant segment of the aging services workforce that provides daily support to older people and individuals with disabilities across settings—placing them on the front lines of this pandemic and at greater risk of being exposed to COVID-19.
Yet these low-wage workers—who primarily are women, people of color and immigrants—often lack paid leave and do not earn enough to weather even a modest disruption in pay. On a daily basis, they are choosing between going to work at the risk of getting infected, potentially infecting others, or staying home and crashing financially. It is an impossible choice that endangers workers and consumers.
Racial equity solutions in aging are essential to the national response to this coronavirus.
A Clear Role for Government and Leaders in Aging and in the Private Sector
The following seven strategies prioritize the needs of people of color—as care recipients and as paid caregivers—during the COVID-19 pandemic. While the ideas focus on racial equity in aging, we also encourage using an intersectional lens that accounts for other dimensions of inequality such as socioeconomic status, location, gender, disability status and sexual orientation.
√ Ensure real-time reporting of data on racial and ethnic disparities in COVID-19 infections, testing rates, hospitalizations and deaths—with an eye toward immediate and localized action solutions. As of early April, most data on racial and ethnic disparities in the COVID-19 crisis came from newspapers and local government agencies—with a promise from federal leaders to report these figures. The entire country needs these insights—and the data should include nursing homes, homecare agencies and other residential care settings.
√ As service providers, quickly survey clients and workers to examine their needs and preferences, and any disparities in access to services and develop a care plan to provide adequate COVID-19 supports. Aging services and long-term-care providers must understand if their services are reaching people of color at the same level as everyone else, and whether people of color have specific barriers to care that merit attention.
√ Implement a racial equity lens in all aspects of service delivery, workforce development and government interventions in aging and long-term services and supports. Those leading the COVID-19 efforts should use racial equity tools, such as the Government Alliance on Race and Equity (GARE) tool, to address racialized health inequities. Similarly, Race Forward offers a practical framework to guide workforce leaders in crafting racial equity solutions. And Justice in Aging delineates a four-step approach: “Denounce racism, acknowledge heightened needs, be culturally competent, and include outreach strategies for various language and cultures.”
The tools exist—what’s needed is the willingness to act. Equally important, the aging network needs to walk the talk by ensuring that adequate and consistent training on diversity, equity and inclusion is offered to their workforce, and to ensure that the racial makeup of their boards and leadership teams reflect the growing diversity of the U.S. population.
√ Advocate for government funding that boosts the aging and long-term-care sectors and the direct care workforce. To implement racial equity strategies, the aging network and the long-term-care sector will need targeted funding—as will the direct care workforce, which is 59 percent people of color. Two top priorities for right now—all direct care workers need personal protective equipment and better training, which can serve to bring new workers into the pipeline and ensure all workers are competent in COVID-19 protocols.
√ Everyone—governments, charities and individuals—should financially support those organizations rooted in communities of color that are well-positioned to assist older people of color and their families. Many care recipients and paid caregivers rely on these groups for support and information, especially in times of crisis. Yet these groups—at the local and national levels—have a long history of underfunding. A boost in funding would help to relieve this inequity.
√ Support older people, family caregivers and direct care workers who are immigrants, as these cohorts face additional biases and hurdles. Anti-immigrant racism is on the rise during this crisis and immigrant-based organizations need support. Providers also should partner with these groups to ensure that immigrants have what they need to get through this pandemic.
√ Provide additional assistance such as paid leave, childcare, transportation, hazard pay and other resources to help all low-wage workers and low-income families. Many low-wage workers will need to keep working, either because they work in essential businesses or because they cannot afford to take time off. We must ensure access to these critical employment supports so workers can remain safe while on the job.
Historically, health and economic outcomes have been tied to an accumulation of opportunity, and the highest bidders benefited tremendously. However, there are two divergent paths ahead of us: On one, we can continue to operate within an aging and long-term-care system full of cracks and inequities that harm the most vulnerable among us. Or we can follow the other path and imagine an entirely new future that embodies resiliency and interconnectivity—a route that affirms we are stronger together than we could ever be in isolation.
Now is the time to take the second path. It’s a new dawn.
Robert Espinoza is vice president of Policy at PHI, in the Bronx, NY, and Jean C. Accius, Ph.D., is senior vice president of Global Thought Leadership at AARP, in Washington, D.C. Espinoza and Accius serve on ASA’s Board of Directors.