Microaggressions: An Approach to Understanding the Health of Workers in Long-Term Care Settings

To the Editor: In recent news, a nurse filed suit against her employer, an assisted living organization, alleging that the organization “failed to protect her from abusive racism from residents.”1 Claims of racism in long-term care (LTC) settings have been reported by minority workers for more than two decades.2 Regrettably, the literature in this area is limited, particularly research addressing the health outcomes of minority staff resulting from negative racial interactions in the workplace.Attesting to the importance of the racial context in LTC, racial and ethnic minorities and immigrants account for more than 50% of the direct care workforce,3 while the older adults who receive care from these workers are on average 80% white.4 Notably, immigrant workers may be at increased risk for negative health outcomes, as they report feeling significantly less respected by both residents and residents' families than workers born in the United States.5 As such, the perspectives of minority workers regarding issues of respect are especially valuable, both because they are the staff who are most often victimized in this manner, and because improved interactions may increase job retention, satisfaction,6 and possibly worker health outcomes.The negative physical and mental health implications of racism have been well documented in the literature.7 Thus, there is good reason to expect that negative racial interactions in LTC settings are additionally problematic in terms of workers' physical and mental health, and that greater attention is needed to address this critical workforce issue as the health of those who provide care may have implications on the quality of caregiving.The concept of racial microaggressions (RMA) is helpful to frame and guide work in this area. Overtly racist acts have now been replaced by more subtle messages surrounding racial inferiority of minority groups:8(p271)