Karin Krause reflects on current issues of racism and ageism and how they tie into her vision for a new model in healthcare.

Systemic Racism is real.  If you are white and grew up in the United States like I did, learning about the policies that were designed to keep people of color poor was not part of our education.  But the policies were real and they affected generations of people of color and their effects are still with us today. 

If you are not an American Indian by heritage, at some point your ancestors came to this country as immigrants.  If they were white, the first generation likely worked very hard at labor jobs while their children ate a little better than they had and received enough education to learn to read and write, add, subtract and multiply.  The second generation often inherited a little money when their frugal parents died.  And that money may have been put into helping the next generation get some job training or go toward the purchase of a home. The next generation had a little more wealth for the third generation to start a business or gain a college education.  

If your ancestors came to this country as slaves, they most likely were not taught to read or write (in fact slave owners could get in trouble for teaching slaves to read and write) and slaves did not die with a savings account.  Fighting for education and the right to earn money came with a civil war and even after the war rights were not equal. Black people earned less for the same work and were only allowed to live in certain areas.  Black zip codes came with higher property tax rates, higher interest rates and greater punishments for even petty crimes.  For example, the fine for jaywalking in some black zip code areas was the equal of two months wages.  So a man could go to prison for an inability to pay such a fine which meant his family could end up losing their home and stability. It was not until the Voting Rights Act of 1965 was signed that barriers at state and local levels could no longer prevent African Americans from voting.  This is systemic racism and it is real.  

According to the Pew Research Center, “While median net worth tends to increase, as levels of educational attainment rise, the white-black gap in wealth persists, even controlling for educational differences. For example, the median net worth of black households headed by someone with at least a bachelor’s degree was $26,300 in 2013, while for households headed by white college degree holders, that net worth was $301,300 – eleven times that of blacks.

The wealth gap between  white and Hispanic households has been consistently large. In 2013 the net worth of white households was roughly ten times that of households headed by a Hispanic ($14,000).”

And in my world of long term care–I see systemic racism.  If you have had time to listen to the story behind the vision for our Therapeutic Interactive Intergenerational Neighborhood (TIIN) you may already know that an important part of the story involved a wonderful Certified Nursing Assistant (CNA) who was having a bad day at work.  As her supervisor I pulled her aside to ask her what was going on–as she was not herself.  This was her story;  She had received financial help to take the class required to become a CNA through the W-2 program started by Tommy Thompson in 1996. Under this program as long as you get some education for a job and then work at that job, you receive help with health insurance and day care. This was a step forward.  However if you made $1.00 over the income guideline you lost all day care and health care benefits.   This CNA had been asked to take on some extra shifts at work.  Being a helpful person she agreed to work on her days off.  This caused her to go over the financial line by $12.00 and she lost benefits.  Being a good problem solver, she found another person in the same situation and they agreed to work different shifts and help each other out with day care.  Great plan!  Except the other person was not reliable–frequently leaving this lovely CNA in a last minute bind.  This had happened again and she called the Director of Nursing (whom she had worked extra shifts for) to say she was sorry but she could not make it to work because of a daycare problem.  The director informed her that if she was going to miss another day of work because of a daycare problem, she would no long have a job.  So, on that very evening, I pulled her aside to see why she was having such a hard time focusing on work.  She asked me if I could go outside with her.  There, she pointed to her rusty car.  It was a hot July evening and the car was running in the parking lot.  She told me, “My babies are in there, my gas gauge is broken, and I keep running out here to make sure it is running so they do not get too hot.”  I asked why they were alone in the car and she told me about the day care problem and the unreliable friend.  As we neared the car, I saw three crying children, two in diapers.  The fear in the children’s eyes and the CNA’s anxiety were overwhelming.  I called an activity therapist and asked if she could come in to set up a spontaneous activity for some residents that couldn’t sleep and some children that needed someone to watch them.  We got through one night.  I asked the Director of Nursing if we could look into providing day care for workers.  The answer at that time was, No.  So I went home and told God I was frustrated and if He had any ideas, I was listening.  That is when the ideas for the TIIN came to me.  And I have been fully focused on them ever since.

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Our current method of identifying a problem and a fix has segregated age groups, economic groups and created inequity all over our country.  We tend to see people groups as a collective problem with a one answer solution.  So we build large affordable housing projects in low opportunity areas and long term care facilities on the edge of town.  However, where a person lives often decides the quality of their health care, education and the food they have access too. This is systemic racism.

It is my extreme belief that the best way to care for people is in diverse communities that intentionally commit to help each other.  Research has caught up with the concept of people needing the social support of each other to flourish.  Children with role models from different generations and socioeconomic groups have been found to develop greater resilience than children from low opportunity neighborhoods without multiple adults as role models in their lives.

In my own life, neighbors became a safety net after the death of my father. My Mother was stressed and resources for after school care were not available.  However a retired neighborhood “grandma” stepped in and I was able to continue to do well at school and was not overcome with the anxiety a neglected child experiences.  When we moved away from our supportive neighbors, toxic stress interfered with my ability to learn for three long years.  Eventually I developed a new support system and I began to catch up in school. Unfortunately, some children never find the support they need.  Hope & A Future is built with the assumption that if we continue to see seniors as a problem we will miss the resource that they are for helping to overcome some of society’s intractable problems.  We hope to provide the equity needed to begin to overcome generational poverty within the context of a diverse intentional neighborhood.  The TIIN joins the efforts of older neighbors and staff to help families with young children.  The older adults gain purpose and belonging as they build relationships with younger people and they receive the support they need in return.  The TIIN is all about developing resilience and the equity needed for each community member to move forward with personally defined roles.  

What does this have to do with systemic racism?  Back to the young mother who was a wonderful CNA and stressed by inadequate resources.  I wonder about a system that funnels people from low socioeconomic backgrounds into jobs where a hard working professional remains in poverty.  And I wonder why medicaid reimburses long term care providers so poorly that they cannot pay their employees a living wage.  Employees are often a flat tire or car repair away from homelessness.  Yet when Covid 19 hit, the government came up with trillions of dollars to give to all Americans whether they needed it or not.  I believe a reallocation of funds in our country could ameliorate the long term care giver workforce crisis.  There are those of us that are born to be caregivers.  But when a CNA can make more money and receive better benefits working at a convenience store than providing care for our country’s vulnerable citizens, we need to wonder who is making decisions about the allocation of funding and what role systemic racism plays in those decisions. 

At Hope & A Future, we have developed a staffing model that can provide a stable home for our live in staff.  And as a result, we are living through the current Covid 19 crisis with a full staff.  We have been looking at resources differently for a long time and sincerely hope we can get others to look at them differently too.  We need some courageous folks to help us become a pilot program for a new kind of housing for older people.  That is housing for older people that helps younger people and builds the surrounding community too!  We are still praying and working to move forward with the next and biggest phase of development of the first complete TIIN.

We would enjoy hearing from you–from a healthy distance!  Please click on the comment box below and let us know your thoughts!  We will look forward to hearing your thoughts and comments!

Thanks for reading!



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