Researcher: racism pushes employees out of care for the elderly

High work pressure, bureaucracy, low wages: these are well-known reasons why more and more healthcare employees are working as self-employed. But the invisible reality is one of racism and discrimination, by colleagues, managers and patients. According to Saskia Duijs, PhD candidate at Amsterdam UMC, this is one of the most important results of her research into the well-being of low-paid care professionals in elderly care who have opted for self-employment.

Duijs, who works in the ethics, law and humanities department of the Amsterdam UMC, started her research four years ago with the idea that these healthcare workers, mainly women, are under enormous pressure when it comes to their health and financial situation. The 153 conversations that Duijs had with care professionals showed that many self-employed people in the care of the elderly, often caring or helping, work hard to make ends meet.

The question why they had chosen self-employment was often answered with the usual reasons: high work pressure, bureaucracy and a low salary. When Duijs heard the term ‘racism’ during one of the interviews, a new insight broke through. From that moment on, this became a theme to ask further questions during the interviews that followed.

What turned out? Racism is an important reason to leave a care organisation, says Duijs. 100 percent of health care workers of color with whom the subject was brought up made it clear that racism was one or sometimes even the main reason for becoming self-employed.

What should we think about when it comes to racism in elderly care?

“Healthcare professionals of color told how they were thwarted during their training by white colleagues who refused to sign off skills because they would not have mastered them, even though they did master them. Others talked about how shifts are traded within a team so as not to have to work with the employee of color. When it comes to salary or education, they don’t always get the chance to grow, unlike their white colleagues. Or they are told that a patient does not want to be cared for by someone of color, and it hurts especially when white colleagues or managers do not stand up for them. It’s not that these examples are said directly, but they do play. Racism often takes place under the skin.”

The book you recently published as a result of your research is entitled ‘What you don’t see’.

“The title refers to the invisible reasons for illness, dismissal or self-employment that are still insufficiently seen and recognised. A professional rather says that ‘hassle’ in the team is the reason to go further as a freelancer than that she honestly says that there is racism.

“I know a team of which six out of ten employees resigned because they experienced racism, while the company doctor who spoke to them all knew nothing about it. In addition, it is not always recognized, or even denied, by white executives or managers. Reporting is then unsafe, because you are quickly pushed into the victim role and labeled as a ‘complainant’.”

You yourself only got to know the theme later during your research. What does that say?

“When I was talking with a fellow researcher of color after that particular interview, the penny dropped. For her, that one clause about racism was big and loaded, while I had more or less talked about it. As a white researcher you have to learn to ask about racism, because you don’t experience it yourself. We are unconsciously incompetent in that regard. Many Dutch studies into health and job satisfaction in elderly care do not pay attention to racism. Until researchers ask for it, we have no figures, and until we have figures, there will be no policy. But that doesn’t mean it isn’t an urgent problem.”

Racism therefore plays a role in the choice for self-employment. What are the consequences for the employees themselves?

“These women of color are overrepresented in low-paid positions because they don’t always get the chance to move up the ladder. The higher up in the healthcare organization, the whiter. As a result, they are more likely to have to deal with poverty, debt and the resulting health problems. We also know from all kinds of studies that racism itself also has an impact on health.

“Once self-employed, many women stack work after work to keep their heads above water. Someone said it aptly: “I’d rather live with financial insecurity than be mistreated.” While deep in their hearts they prefer to work in an organization, and could have been kept there too, if more attention had been paid to a theme such as racism. They are not attracted to the self-employed, but they are pushed out of their own organization.”