Chapter 8: Rural African American Older Adults and the Black Helping Tradition

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Chapter 8: Rural AfricanAmerican Older Adults and theBlack Helping TraditionMikal N. Rasheed PhD & Janice Matthews RasheedDSWPublished online: 22 Sep 2008.

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Chapter 8

Rural African American Older Adultsand the Black Helping Tradition

Mikal N. Rasheed, PhDJanice Matthews Rasheed, DSW

SUMMARY. By the year 2050, 21 percent of all Americans over 65 willbe members of a minority group with African Americans being the largestsubgroup. What is critical is that there are great disparities in the physicaland mental health status, service availability, service access, and socioeco-nomic factors between elderly African Americans and elderly whites. Thesedisparities are even more evident with older African Americans in ruralcommunities. Along with these disparities, coupled with the “helping tradi-tion” in the African American community, there has been a great reliance oncommunity-based informal care systems for elderly African Americans.

This chapter will examine the informal care systems in rural AfricanAmerican communities within the context of the helping tradition foundwithin the African American cultural history. In this examination there willbe a discussion of how the gaps in the social services delivery system in ru-ral communities reinforce this helping tradition. [Article copies available fora fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mailaddress: <[email protected]> Website: <http://www.Haworth Press.com> © 2003 by The Haworth Press, Inc. All rights reserved.]

[Haworth co-indexing entry note]: “Rural African American Older Adults and the Black Helping Tradi-tion.” Rasheed, Mikal N., and Janice Matthews Rasheed. Co-published simultaneously in Journal of Geronto-logical Social Work (The Haworth Social Work Practice Press, an imprint of The Haworth Press, Inc.) Vol. 41,No. 1/2, 2003, pp. 137-150; and: Gerontological Social Work in Small Towns and Rural Communities (ed:Sandra S. Butler, and Lenard W. Kaye) The Haworth Social Work Practice Press, an imprint of The HaworthPress, Inc., 2003, pp. 137-150. Single or multiple copies of this article are available for a fee from TheHaworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. - 5:00 p.m. (EST). E-mail address:[email protected]].

http://www.haworthpress.com/web/JGSW 2003 by The Haworth Press, Inc. All rights reserved.

Digital Object Identifier: 10.1300/J083v41n01_08 137

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KEYWORDS. Black helping tradition, older African Americans, ruralAfrican Americans

INTRODUCTION

The dramatic growth of the aging population has created new chal-lenges for the social work profession, calling for a growing demand fora variety of health, mental health, and social services (Rosen & Zlotnik,2001). While social work has a long history in working with olderadults in a variety of settings, the elderly population is increasing bothin number and in diversity, thus reshaping the American demographiclandscape (Torres-Gill & Moga, 2001). In the last century while theU.S. population tripled, the elderly population, including those over 65,increased 11 fold (U.S. Census, 1996). The U.S. 2000 Census foundthat 12.4 percent of the population was over 65. This percentage is ex-pected to increase to 15.7 percent by 2020 and to 21 percent by 2040(U.S. Census, 1996, 2000; Day, 1993; Torres-Gill & Moga, 2001). Bythe year 2050, 21 percent of all Americans over 65 will be members of aminority group, with African Americans being the largest subgroup(Ford & Hatchett, 2001). What is critical is that there are great dispari-ties in the physical and mental health status, service availability, serviceaccess, and socioeconomic factors between elderly African Americansand elderly whites. These disparities are even more evident with olderAfrican Americans in rural communities. Along with these disparities,coupled with the “helping tradition” in the African American commu-nity, there has been a great reliance on community-based informal caresystems for elderly African Americans.

This chapter will examine the informal care systems in rural AfricanAmerican communities within the context of the helping traditionfound within the African American cultural history. In this examinationthere will be a discussion of how the gaps in the social services deliverysystem in rural communities reinforce this helping tradition. Finally,the authors will recommend ways in which social services might moreeffectively address some of the human service needs of older AfricanAmericans within the context of this helping tradition.

RURAL AFRICAN AMERICAN OLDER ADULTSAND INFORMAL CARE

Aging and the African American Experience

One of the most vulnerable populations within the African Americancommunity is older adults. There are in excess of two and one half mil-

138 Gerontological Social Work in Small Towns and Rural Communities

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lion African Americans age 65 and older in the United States. This fig-ure represents about 8% of the total African-American population(Barresi & Menon, 1990; Spence, Yogtiba, Perry, & Black, 1998). El-derly African Americans are increasing at a rate almost twice the rate ofthe African American population as a whole. By the year 2050 the pro-jected number of African American older adults could reach 9 millionor 15% of the total African American population (Cowgill, 1988). Thevulnerability of this population is underscored by the following statis-tics:

1. African Americans have a shorter life expectancy than whiteAmericans; 64.9 years for African American men compared to73.2 years for white men; 74.1 years for African Americanwomen compared to 79.6 years for white women (Williams,Padgett, Blank, Guarini, Morton, Wilson, & Simmons, 2001). Cu-riously there is a cross-over phenomena in which African Ameri-can males and females who reach the age of 73 and 85 respectivelylive longer that Whites (Greene & Seigler, 1984).

2. Older African Americans have a disproportional number ofchronic health and health related problems, higher levels of func-tional dependence and a greater need for assistance than olderWhites (Bane, 1991; Harper & Alexander, 1990; Hooyman &Kiyak, 2002). For example, older African Americans suffer dis-proportionately from hypertension, diabetes, and kidney prob-lems (Spence, Yogtiba Perry, & Black, 1998).

3. Older African Americans experience greater disability and re-quire more restricted days in bed that their older White counterparts (Hooyman & Kiyak, 2002).

In spite of these alarming statistics, Holmes and Holmes (1995) ad-dress ways in which the experience of aging are perceived differentlyand in some respects more positively, for African Americans as com-pared to whites. Holmes and Holmes (1995, pp. 188-189) state that it ispossible to generalize that African Americans:

• See old age more as a reward than a disaster• Have fewer anxieties about old age and therefore higher morale• Are less likely to deny their actual age• Tend to remain part of their family structure to a greater degree

and consequently are more respected and better treated

Section III. Special Populations 139

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• Are strongly supported by bonds of mutual assistance (withfriends, neighbors and family)

• Are more likely to maintain useful and acceptable family functions• Are more likely to be tolerated by their families in spite of behav-

ioral peculiarities• Are generally more religious but less involved in economic and

political institutions• Are considerably less prone to commit suicide.

These characteristics of the aging experience in African Americancommunities may seem to suggest a more positive experience with theaging process among African Americans. Yet social problems such aspoverty, lack of access to services, and racially or culturally insensitiveservices can mitigate against these seemingly positive orientations to-ward the aging process among African Americans. Additionally thereare multiple factors in rural America that can contribute to the harshnessof the aging experience for rural African Americans.

Rural African American Older Adults

In rural America the situation of African American elders reflectsgreater vulnerability than that of urban African American elders. Thelack of appropriate senior services is indeed complicated by the lack ofsocioeconomic resources available to rural African American olderadults. The lack of resources is compounded by the financial and physi-cal realities of rural living–a reality where nearly 50% of all black elderslive in poverty. Rural African American elders are additionally im-pacted by low literacy levels, poverty, poor and chronic health condi-tions, lack of transportation and housing (Wan, 1977; Wood & Wan,1993). These factors contribute to the lack of knowledge of, access to,and ability to afford services.

Wood and Wan (1993) raise critical concerns about the nature of ser-vices that are available for rural elders, especially African American el-ders. The general network of formal community-based care for theelderly include: (1) in-home services, including skilled nursing, physi-cal therapy, home health aide services and homemaker services; (2) ger-iatric day care and other support services such as home delivered meals,adult foster care and transportation; and (3) respite care, emergencylodging, or community housing options. In rural areas these facilitiesand services, other than institutional care in the form of nursing homes,are not as easily available.


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One of the unique issues impacting social service development is thenature of community in a rural context which is scattered in terms ofcovering a large geographic area, with limited numbers of people. AsWood and Wan (1993) clearly point out, the social life of a rural com-munity is usually centered on a general store, post office, or church. Pat-terns of interaction are informal and based on face-to-face contact.Much value is placed on knowing community residents personally. Insuch community settings, the chief providers of mental health services,especially to the aged, are likely to be the general practitioner and localminister.

Even though there is a paucity of elderly services in rural communi-ties, there are certain practices and attitudes among elderly AfricanAmericans, particularly elderly rural African American women thatshape their health protective behaviors (Wilson-Ford, 1992). Heath pro-tective behavior are those behaviors performed by a person regardlessof their perceived health status, in order to protect, promote or maintaintheir health regardless of whether that behavior is effective toward thatend (Harris & Guten, 1979). These health protective behaviors amongrural African American older adults include such practices as:

• Ignoring illness related symptoms until the condition becomes dis-abling

• Using prayer, living by religious principles, and using home reme-dies and self-medication as selective responses to symptoms andillnesses

• Denying the existence of health problems in order to maintain asense of independence and self-reliance.

These health protective behaviors of elderly rural African Americansis grounded in a cultural ethos and belief system found in rural AfricanAmerican communities. These beliefs support the importance of usingreligious faith to protect health rather than traditional medicine or for-mal health care systems. Additionally there is the cultural belief that tobe ambulatory is a sign of health in spite of biological and medical dis-turbances.

While there is the existence of a rural cultural ethos that relies on folkbeliefs, self-help and self-care, there is also a reliance on a network ofinformal support and care systems that are family and/or community-based (Carlton-LaNey, 1992). Due to experiences with racism, discrim-ination, and personal histories of encountering injustices from formalsupport systems of care, older African Americans in rural communities


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have relied on a “helper network” (Chatters, Taylor, & Jackson, 1986)that includes spouses, children, siblings, friends, neighbors, andquasi-formal institutions such as the community church.

This helper network is the basis for informal caregiving for those olderpersons who find themselves unable to maintain complete self-care dueto illness or physical infirmities. Informal caregiving for older persons isclassified as instrumental and affective assistance (Barresi & Menon,1990; Chatters, Taylor, & Jackson, 1986; George, 1988; Jackson, 1971,1972). Instrumental assistance includes such support as grocery shop-ping, transportation, and meal preparation. Affective or expressive as-sistance includes emotional support, giving advice, encouragement,companionship, and prayer (Spence, Yogtiba Perry, & Black, 1998).Research does not support the idea that the family as such is the primarycare giver. In fact there are a variety and range of significant informalsupports including family, extended kin and non-kin, including churchmembers, neighbors, and friends (Chatters, Taylor, & Jackson, 1986;Wood & Parham, 1990). This vast support network appears to performfunctions that close relatives more likely perform in white families(Wood & Wan, 1993). Additionally within the support network is theconcept of reciprocity that arises out of the African American sense ofcommunity and the African American helping tradition (Martin & Mar-tin, 1985). Older adults, including frail elders, may provide child care,shared housing, or financial assistance to younger family members inneed of aid. In return, health care and transportation services are pro-vided informally by friends and relatives in order to allow the older in-dividual to live out his/her life within the context of home andcommunity (Wood & Wan, 1993). In spite of the fact that many of thecaregivers are themselves likely to be in poverty or near poverty levels,the African American sense of community and the black helping tradi-tions persist as the cultural foundation for providing informal care toAfrican American older adults.

THE AFRICAN AMERICAN EXPERIENCE OF COMMUNITYAND THE AFRICAN AMERICAN HELPING TRADITION

The African American Sense of Community

Being a part of a unique community has long dominated the socialconsciousness of African Americans. This sense of “peoplehood” hasemerged from a commonality of experience. These experiences result


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from a collective response to the forces of racism and oppression. Not-withstanding the debilitating impact of these forces, the African Ameri-can community has contained a reservoir of strength and resourceswhich often go untapped and/or unrecognized. Relying on this commu-nal strength, African Americans have historically formed communal asso-ciations to pursue the attainment of civil rights, individual choice andlegitimating claims for institutional and psychological liberation (Blackwell,1975). These networks of community support have historically been thesource of strength and resiliency for the African American community’smost vulnerable members.

What are the factors that distinguish the African American commu-nity from other communities? Several social scientists have identifiedsome distinctive characteristics of the African American community(Billingsley, 1992; Blackwell, 1975; Solomon, 1976). Geographically,many African Americans live in segregated neighborhoods in whichmost of their neighbors are also African Americans. These geographiccommunities, also known as “Black communities,” although not alwayscommunities of choice, are often marked by a sense of personal intimacyand social cohesion. In many instances these geographic communitieshave also been marked by social, economic, and political isolation. Thisis especially the case within rural communities wherein ethnic minoritiesare sparsely populated. However, these communities have played an im-portant role in shaping and reinforcing a sense of racial and culturalidentity.

On a cultural level, the African American community can be de-scribed as representing multiple perspectives. Each perspective is shapedby the historical and traumatic experiences of enslavement. One perspec-tive emphasizes a deep and rich cultural connection with an African heri-tage. Another perspective reflects an assimilation of Euro-Americanculture. The third and most dominant perspective reflects a culture repre-senting varying degrees and mixtures of both African and Euro-Ameri-can cultural frames of reference. The final perspective represents a stateof alienation and disaffiliation from any viable and sustaining culturalperspective. This perspective represents those who have no buttressagainst the forces of racism and poverty.

These perspectives are represented in the diverse life styles and cul-tural perspectives of individual African Americans. From these diverseperspectives, a rich and diverse community with a unique history andheritage has emerged. Correspondingly, a set of institutions and organi-zations that identify with this heritage have developed. These organiza-tions and institutions form the sustaining and nurturing infrastructure of


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the African American community. Such institutions and organizationsinclude African American churches, mutual aid societies, fraternal or-ders, women’s clubs, unions, orphanages, senior citizen homes, hospi-tals, educational institutions, protest movements, and race consciousnessorganizations (Martin & Martin, 1985).

Grounded in the historical, social and economic experiences of Afri-can Americans, these institutions shape the communal experiences ofAfrican Americans. They form the nucleus for the tradition of self helpwithin the African American community (Martin & Martin, 1985). Ascommunity-based institutions, they provide for the experience of col-lectivity, in that they are the repositories of the communal narratives.These community-based institutions provide the format for communalcelebration; and hence they provide succor and care during individualand/or communal tragedies.

The African American Helping Tradition

One domain in which the African American sense of community isevident is in the traditional forms of helping and mutual aid, self-helpand informal social support. Informal social support can be defined as“an interwoven network” (Lubben & Becerra, 1987, p. 130) of familyand friends who without training for the provision of care, undertake toprovide a variety of services without compensation yet with a sense ofobligation, loyalty or love (Barker, Morrow, & Mitteness, 1998). Mar-tin and Martin (1985, pp. 4-5) describe the key concepts that recurthroughout this communal sense of self-help.

• The African American helping tradition refers to the largely inde-pendent struggle of African Americans for their survival and ad-vancement from generation to generation.

• The African American extended family consists of a multigenerationalinterdependent kinship system held together basically by a sense of ob-ligation to the welfare of members of the kin network.

• Mutual aid, a dominant element in extended family life, involves areciprocal effort of family members to pool the resources neces-sary for survival and growth.

• Social-class (status-group) cooperation is the endeavor of familymembers of different incomes, educational and social class levelsto downplay class distinctions in giving and receiving aid.

• Prosocial behavior involves the attitudes and practices of coopera-tion, sharing, and caring that black adults consciously strive to in-


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still in African American children so the tradition of blackself-help will be passed on to future generations.

• Fictive kinship is the care giving and mutual-aid relationshipamong non-related African Americans that exist because of theircommon ancestry, history and social plight.

• Racial consciousness is the keen awareness by many AfricanAmericans of their history and condition as a people and theiroverwhelming desire to uplift their race to a state of dignity andpride.

• Religious consciousness refers to deliberated attempts of AfricanAmericans to live accordingly to those religious beliefs that callfor acts of charity and brotherliness and neighborliness toward oneanother as a means of coming closer to God and carrying outGod’s will.

In various African traditions as well as among African Americans,there is clear veneration of the elders. With age comes wisdom and re-spect. Among the Ashanti, elderly men and women were the ones whohad accurate knowledge (Rattray, 1923; Holmes & Holmes, 1995). InWest Africa, elderly men and women were give respect by kin andnon-kin alike and were referred to as “grandfather” and “grandmother”(Wylie, 1971). Notwithstanding their close affinity to the ancestors byvirtue of their age, the elders as grandparents served as importanceagents of socialization. Within traditional African American culture,and especially in rural culture, the elderly African Americans, espe-cially grandmothers (Barer, 2001), maintain the role of matriarch,kinkeeper, perpetuators, models and finally benefactors of this helpingtradition.

The African American Church: An Institutional Expressionof the Helping Tradition

The African American church is one of the primary structures in theAfrican American community. No other institution claims the loyaltyand attention of African Americans including elderly African Ameri-cans as does the Black church (Boyd-Franklin, 1989; Taylor, 1985;Taylor & Chatters, 1986). The African American church can be de-scribed as an ontological community or a community of meaning in thatit provides the spiritual, emotional, and existential meaning and sup-ports for a vast group of African Americans (Brueggemann, 1996). For


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many, the African American church symbolizes the heart and soul ofthe community.

The church as a community institution serves multiple functions as itaddresses the needs of African Americans. The church is a source ofpsychosocial support and can have an impact on every aspect of life. Inaddition to providing African American families with social servicessuch as senior citizen activities, child care, educational groups, parentinggroups, and housing development, the church also provides latent func-tions such as helping to maintain family solidarity, conferring of socialstatus, leadership development, release of emotional tensions, social/po-litical activity, and recreation (Staples, 1991).

Because the African American church has been ever present in theprovision of human services, it has become an alternative social servicedelivery system for many African American families, and in this sensean institutional expression of the African American helping tradition.This is especially true for older African Americans in the rural areas.For example, elderly African Americans turn to their church for assis-tance more than elderly whites when community-based services are notavailable (Cantor & Mayer, 1978). Further, elderly African Americansrely on informal assistance from the church second only to support pro-vided by their families (Dancy, 1977; Taylor & Chatters, 1986;McGadney, 1997). Given the extensive use of informal care supportamong rural African American elders, a question could be posed re-garding the role of formal care services for older African Americans inrural communities. The next section will examine that concern.

FORMAL CARE SYSTEMSFOR RURAL AFRICAN AMERICAN OLDER ADULTS:

IMPLICATIONS FOR SOCIAL WORK INTERVENTION

Some of the key problems in the developing and implementing ser-vices to older adults in rural communities are summarized by Krout(1992, p. 4) when he states that:

• Compared to urban elders, rural older persons generally have ac-cess to a smaller number of and more narrow range of commu-nity-based services, especially services for the severely impaired.

• Clear gaps exist in the continuum of care in rural communities,with few alternatives for those who cannot live independently butdo not require institutionalization.


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• Too little attention has been given to designing service deliverymodels and strategies specifically for rural areas and populations.

For Wood and Wan (1993) the gaps in continuum of care and pooraccess to services can create a greater reliance on informal care as theprimary mode of services for rural elders. The use of informal care asthe primary mode of service provision to rural African American eldersis particularly evident due to an array of sociocultural and economicfactors. There are many challenges in developing formal services. Onechallenge is found in the characteristics of many rural communities.These characteristics include low population density and size, which inturn can impact service access due to lack of transportation, and a lackof available information about existing though limited services.

Another challenge for rural communities is inadequate state and fed-eral funding for elder services and restrictive and culturally insensitiveelder services. Krout (1994) points out that in planning, implementing,and evaluating elder services in rural communities, they must be exam-ined in terms of their availability, accessibility, appropriateness, accept-ability, awareness, affordability, and adequacy.

We might add the factor of cultural competence as a challenge, espe-cially as it relates to services for African American elders. Culturallycompetent services should involve the recognition and utilization ofhealth protective behaviors and the health belief systems that are part ofthe cultural fabric of rural African American culture. These culturallycompetent services should also acknowledge and incorporate the Afri-can American helping traditions as a part of the service delivery design.A provider must bear in mind that due to the minority status of AfricanAmerican elders and their experiences with discrimination and racism,they are sensitive to the lack of respectful treatment by white serviceproviders (such as the use of first name, etc.). Thus they would ratherrely on the informal care system than to experience or re-experiencediscrimination.

SOCIAL WORK INTERVENTIONSWITH THE RURAL AFRICAN AMERICAN OLDER ADULTS

The goals for social work with this population are three fold: (1) tosupport and enhance those informal community-based levels of care forrural elderly African Americans that will allow them to function inde-pendently in their own homes, or homes of family utilizing the strengthof the extended informal support network that exists in rural areas;


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(2) to facilitate and expand the helping network to solve the psychosocialproblems of African American rural older adults; and (3) to strive to cre-ate sound formal care organizations that can provide culturally compe-tent services to rural African American elders. The latter goal is signifi-cant in that not all the physical and mental health issues of African Amer-ican elders can be addressed through community-based informal supportand caregiving. Community-based human service programs or long-termcare facilities are necessary for a significant number of these individuals.

Social workers who work with older African Americans in ruralcommunities should: (1) design strategies of intervention and supportservices within the sphere of religion or embedding these interventionsand support services within the rural African American church; (2) ad-vocate for increased financial support and governmental funding forthose caretakers “recruited” by the older adult from their helping net-work; and (3) involve the elders in the service planning, implementa-tion, and delivery of rural and community-based elder care systems.Such interventions would create avenues for participation, belonging,and mutual aid and support for elderly rural African Americans.

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Documents

Chapter 8: Rural African American Older Adults and the Black Helping Tradition