Is Discrimination Running Rampant in Our Long-term Care Facilities?

Is Discrimination Running Rampant in Our Long-term Care Facilities?


It has been almost 50 years since Title VII of the Civil Rights Act outlawed workplace discrimination. Despite this law, discrimination is still taking place at some long-term care facilities where patients are refusing to be cared for by health care professionals of races different from themselves.

The federal appeals court in Indiana recently highlighted this type of discrimination in the case, Chaney v. Plainfield Healthcare Center. In this case, Brenda Chaney, a black certified nursing assistant (“CNA”) sued her employer for race discrimination. Ms. Chaney’s patient refused to be cared for by any black CNAs. The employer ratified this discrimination and specifically wrote on Ms. Chaney’s daily assignment sheet” “[Patient] Prefers No Black CNAs”. Ms. Chaney faced daily discrimination, at the hand of her co-workers and the patient, due to the patient’s request.  Despite adhering to the patients’ racial preferences and enduring abuse from co-workers, Chaney was fired after only three months of work.

Ms. Chaney’s employer misinterpreted the phrase “patients’ right to choose their care provider” as allowing patients to engage in blatant race discrimination against health care professionals. This case highlights a significant gap in the law between Title VII and the Federal Nursing Home Reform Act (“Reform Act”). Consequently, care facilities rightfully fear getting caught in the grey area between properly adhering to patient’s rights under the Reform Act, while maintaining the rights of its employees pursuant to Title VII. Given that the precedential value of the Chaney decision will govern only a small number of long-term health providers in the jurisdiction of the Chaney court, Congress should amend the Reform Act by adding a nondiscrimination provision similar to Title VII.  Amending this Act will ensure that other health care professionals like Ms. Chaney won’t have to suffer the indignity of discrimination by a patient who refuses to be cared for by the health care provider because of her race.

In addition to passing legislation to amend the Reform Act, long-term care facilities need to take steps to stamp out discrimination.  In general, they need to ensure that their staffs and patients are able to effectively communicate with each other. These facilities need to ensure that their staffs are also culturally diverse and competent. Cultural competency training may foster more long-term trust between patients and staff especially when individuals of a different culture, race or religion are caring for patients.

In addition to providing cultural competency training, care facilities should work with patients to reform behavior to prevent racially hostile work environments.  Behavior contracting reforms a patient’s behavior by articulating the express behavior expected of the patient and the patient’s expressed needs of the long-term care facility.   The contract could include a nondiscrimination provision as well as provisions providing for the education of care providers so they will better understand the patient’s beliefs, cultural preferences, and wishes for personal care.

Through a collaborative effort of the judiciary, the legislature, and long-term care providers, health care providers can be free of the discriminatory conduct that Ms. Chaney faced. Through these efforts, nondiscrimination principles can be engrained in the long-term health care industry. The sooner obvious intolerance is dealt with the less harm it will have on individual members of society and society has a whole.

Guest Contributor Sara Gronningsater is a student at St. John’s, editor-in-chief of the Journal of Civil Rights and Economic Development and a member of the Moot Court Honor Society.


  1. Sounds like someone wants their cake and to eat it too? First, now a patient doesn’t have rights because he wants to chose his own care. Then, the hospital HAS to hire specific people of color. Which policy is racist? Forcing a patient to do something they do not want or forcing “color” down everyone's throat? And, what ? Indiana? I thought all these Yankees were soooo accepting of everyone and it was only Southerners that were racist? What happened to the Lincolnites in Indiana or are all just in IL?