Discrimination in Long-Term Care Facilities: Legal Consciousness and Problem-Solving Among Staff

Abstract

Abstract Over half of direct care workers in long-term care facilities are women of color. Building on legal consciousness theory–which explains how individuals invoke legal principles to define everyday experiences–this study examines how staff understand and resolve discrimination between residents and staff and among staff. This study employs a multi-method qualitative extended comparative case approach. Data includes in-depth semi-structured interviews (n=80) and participant and non-participant observation (n=8 months) at two facilities that vary in staff racial composition. Findings reveal rampant unreported instances of race and sex discrimination toward Black staff by white staff and residents. Black staff at all levels did not invoke rights or discrimination rhetoric when they experienced overt race discrimination by residents but engaged in significant emotional labor to respond to race discrimination by residents. Black staff, however, perceived microaggressions and unequal treatment by white staff as discrimination. At both facilities, floor staff and management adopted diverse team approaches across race and staff hierarchy for responding to race discrimination by residents toward Black female staff. These findings suggest the need for new and targeted policy and practice approaches that recognize extensive emotional labor expended by staff of color when addressing discrimination by residents and challenges from white staff when addressing race discrimination by staff. These findings have theoretical implications by extending legal consciousness theory to multi-level staff understandings of discrimination. Findings also provide useful tools and case examples for policymakers and practitioners interested in racial justice, particularly given how COVID has exacerbated racial inequities in long-term care.