Spending much of the past five days at Tallahassee's old community hospital and visiting - by now - six rehab clinics/nursing home-rehab clinics - I've gotten to see first hand racial, class, and gender segregation in the health care sector.
Here at TMH the doctors are white men, the techs (formerly called orderlies) are mainly assertive African-American women. The nurses are white women - many young and petite - while the "charge nurses" are also white, but some are a little older. The Florida State University nursing students are young white women and all petite (with their white uniforms), and the Lively VoTech and Florida A&M University student nurses are all African American women. The Lively Vo Tech students are studying to Licensed Practical Nurses, so they won't have bachelor's degrees and may have less status than their (FAMU- and FSU-trained) counterparts. There are a few outlier catgories and people - a physician's assistant is a man, both of the physical therapists are women (but one is Filipino American), one night-time nurse is a (Chinese-Filipino-American) man, and we've worked with one. But, on the whole, the staff is very segregated internally.
Many of the patients, it appears, are white, some lower-middle-class, and some from or with roots in the outlying areas around Tallahassee. We've talked with student nurses from all over Florida and Georgia.
I found analogous divisions of labor in the nursing homes and rehab clinics. The two clniics that Blue Cross apparently won't pay for are top-of-the-line, with preomdinantly professional-manageral-class white patients and many white staff. At the two clinics I visited most recently, I suspect there is a more working-class patient mix, something like half and half white and black or perhaps majority white. I suspect these clinics take more patients receiving Medicaid and have more relaxed rules about sliding patients from rehab (short-term care) to nursing home (long-term care) (and at one of these I noticed a more working-class - and from our point of view - less health menu, and I also noticed the call bell at the nursing station going on and on - meaning they're not answering patients' calls - though they gave me a tour perhaps instead of doing so - though Emory reminded me that the calls might be from patients that push the call button every couple of minutes no matter what - in these facilitities in the nursing home areas were Alzheimers patients, some of whom the staff must watch constantly) - whereas the high-end places just take patients with high-end insurance - or personally wealth - and then only take rich residents or residents with long-term care insurance in their nursing home sections.
(In a way this hospital - certainly at night - resembles an elementary school, when almost the entire staff is women - including women in charge (the "charge nurse"). At least for individuals in this situation, we're almost entirely at the mercy of these women - who, by their decisions and actions, can help determine whether we live or die, whether we're in comfort or in pain, and whether we get by with face or humiliation - just as we entrust our young children to elementary schools run almost entirely by women.)
We'll see what happens if I go Tuesday morning to a nursing home (and hopefully also rehab clinic) run by a black church that two white church members (one of them in there) have recommended strongly.
Some of these visits have reminded me of the nursing home my Grandma spent her last couple of years at (sign pictured above). It was a continuous adjustment for my Grandma - getting used to all of these new people around and getting used to being dependent on others for care (a challenge my Mom faces now - she's had almost no contact with other patients, as she has her own room and of course she eats all of her meals in her room - but wherever she goes she'll have no private room next).
Columbus is a different city - with much bigger African immigrant and Latino populations - and Grandma's suburban Central Ohio nursing home was mainly white (with Grandma occupying one of the few Medicaid-designated beds) except for many of the techs/orderlies were Somalian American. The person we talked with most was Ali, a man like some other African immigrants used to be professional-managerial class at home. The night Grandma died I stopped by on the way from a wedding - with a sport jacket and tie - and spent a little time with Grandma. On my way out I had one of my longest conversations with Ali. He said he used to wear ties to work, and he hoped to some day get a more professional job in Columbus.
All of this had presented a confusing class and race mix. Grandma, who no doubt all her life had like many lower-middle-class whites of her generation harbored episodic prejudice against African-Americans, spent much of her final days in the care of (in addition to care by my aunts who visited frequently) African Americans and African immigrants - albeit some Somalian with more schooling than Grandma.
(Grandma died and then I left Central Ohio and by the time I went back to the nursing home four months later Ali was no longer working there and his name was so common, much to my regret. Part of the problem was that I flew back to Ohio for the funeral and got to the viewing a couple of hours late after many of the nursing home staff had already visited - she was a pretty popular resident. To this day I regret that I did not get to thank the staff - I wrote thank you notes in August to a number of professionals and volunteers at the nursing home and hospice - all white - but did not/could not find information on the tech staff. You spend a lot of time with these folks - not only the nursing home staff but now the hospital staff - and then suddently you drop out of each other's lives. (In Mom's case she may be back in a year or so to do this all over again with her other knee, and I have also - at least with the hospital staff - been trying dutifully to get pictures of everyone and take pictures of the board that usually lists all of their names.) I wonder where Ali went next and whether he ever landed a professional job.
Here at TMH the doctors are white men, the techs (formerly called orderlies) are mainly assertive African-American women. The nurses are white women - many young and petite - while the "charge nurses" are also white, but some are a little older. The Florida State University nursing students are young white women and all petite (with their white uniforms), and the Lively VoTech and Florida A&M University student nurses are all African American women. The Lively Vo Tech students are studying to Licensed Practical Nurses, so they won't have bachelor's degrees and may have less status than their (FAMU- and FSU-trained) counterparts. There are a few outlier catgories and people - a physician's assistant is a man, both of the physical therapists are women (but one is Filipino American), one night-time nurse is a (Chinese-Filipino-American) man, and we've worked with one. But, on the whole, the staff is very segregated internally.
Many of the patients, it appears, are white, some lower-middle-class, and some from or with roots in the outlying areas around Tallahassee. We've talked with student nurses from all over Florida and Georgia.
I found analogous divisions of labor in the nursing homes and rehab clinics. The two clniics that Blue Cross apparently won't pay for are top-of-the-line, with preomdinantly professional-manageral-class white patients and many white staff. At the two clinics I visited most recently, I suspect there is a more working-class patient mix, something like half and half white and black or perhaps majority white. I suspect these clinics take more patients receiving Medicaid and have more relaxed rules about sliding patients from rehab (short-term care) to nursing home (long-term care) (and at one of these I noticed a more working-class - and from our point of view - less health menu, and I also noticed the call bell at the nursing station going on and on - meaning they're not answering patients' calls - though they gave me a tour perhaps instead of doing so - though Emory reminded me that the calls might be from patients that push the call button every couple of minutes no matter what - in these facilitities in the nursing home areas were Alzheimers patients, some of whom the staff must watch constantly) - whereas the high-end places just take patients with high-end insurance - or personally wealth - and then only take rich residents or residents with long-term care insurance in their nursing home sections.
(In a way this hospital - certainly at night - resembles an elementary school, when almost the entire staff is women - including women in charge (the "charge nurse"). At least for individuals in this situation, we're almost entirely at the mercy of these women - who, by their decisions and actions, can help determine whether we live or die, whether we're in comfort or in pain, and whether we get by with face or humiliation - just as we entrust our young children to elementary schools run almost entirely by women.)
We'll see what happens if I go Tuesday morning to a nursing home (and hopefully also rehab clinic) run by a black church that two white church members (one of them in there) have recommended strongly.
Some of these visits have reminded me of the nursing home my Grandma spent her last couple of years at (sign pictured above). It was a continuous adjustment for my Grandma - getting used to all of these new people around and getting used to being dependent on others for care (a challenge my Mom faces now - she's had almost no contact with other patients, as she has her own room and of course she eats all of her meals in her room - but wherever she goes she'll have no private room next).
Columbus is a different city - with much bigger African immigrant and Latino populations - and Grandma's suburban Central Ohio nursing home was mainly white (with Grandma occupying one of the few Medicaid-designated beds) except for many of the techs/orderlies were Somalian American. The person we talked with most was Ali, a man like some other African immigrants used to be professional-managerial class at home. The night Grandma died I stopped by on the way from a wedding - with a sport jacket and tie - and spent a little time with Grandma. On my way out I had one of my longest conversations with Ali. He said he used to wear ties to work, and he hoped to some day get a more professional job in Columbus.
All of this had presented a confusing class and race mix. Grandma, who no doubt all her life had like many lower-middle-class whites of her generation harbored episodic prejudice against African-Americans, spent much of her final days in the care of (in addition to care by my aunts who visited frequently) African Americans and African immigrants - albeit some Somalian with more schooling than Grandma.
(Grandma died and then I left Central Ohio and by the time I went back to the nursing home four months later Ali was no longer working there and his name was so common, much to my regret. Part of the problem was that I flew back to Ohio for the funeral and got to the viewing a couple of hours late after many of the nursing home staff had already visited - she was a pretty popular resident. To this day I regret that I did not get to thank the staff - I wrote thank you notes in August to a number of professionals and volunteers at the nursing home and hospice - all white - but did not/could not find information on the tech staff. You spend a lot of time with these folks - not only the nursing home staff but now the hospital staff - and then suddently you drop out of each other's lives. (In Mom's case she may be back in a year or so to do this all over again with her other knee, and I have also - at least with the hospital staff - been trying dutifully to get pictures of everyone and take pictures of the board that usually lists all of their names.) I wonder where Ali went next and whether he ever landed a professional job.
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