the nursing home, staff need to know at least some of the basic vocabulary of the residents, and it is important that someone, either volunteer or staff, be available for translation when elders speak limited English (Snyder, 1982).
Problems related to cultural and racial diversity are particularly acute in urban nursing homes, where a majority of staff may belong to minority groups, whereas the residents are predominantly white. Preliminary findings from a study of ethnic and racial conflict between nursing home staff and residents in New York revealed a high prevalence of racially charged verbal abuse and name calling of aides by residents (Teresi et al., 1994).
There is a lack of research and thus an inadequate knowledge base about the long-term health care needs of minority elders and other age groups. The research that does exist strongly suggests some disparity of service use and inequity of access for ethnic and minority populations, despite increased need (Barresi and Stull, 1993). While the general growth of the elderly population in the United States is well known, the increase in racial and ethnic elderly populations is less well recognized. Yet the elderly population is increasing faster among ethnic and racial minorities populations (Hispanics, American Indians, African Americans, Asians, and Pacific Islanders) than among whites, and the total population of ethnic and minority elderly has doubled with each national census since 1960 (Harper and Alexander, 1990). In some parts of the country, these ethnic and minority elderly will soon be the majority among the population aged 65 years and older (Cuellar, 1990; Morioka-Douglas and Yeo, 1990; Richardson, 1990). In 1985, approximately 14 percent of the population 65 and over were persons of color (Elders of Color, 1991). A significant increase in the population 85 years of age and older and in the number of females is also occurring, and a substantial proportion of these elderly are of racial and ethnic minorities.
Despite having poorer health and less help from relatives than comparison groups of white elders, black elders are less likely to be institutionalized. At comparable rates of frailty, the likelihood of nursing home admission for blacks is less than half that of whites (Belgrave and Bradsher, 1994). Poverty, geographical isolation, and discrimination are now given more weight in this pattern than the previous characterization of personal preference.
Although the Indian Health Service (IHS) has a statutory responsibility to meet the health needs of American Indians, it tends to define its mission in terms of acute care. As a result, the rapidly increasing long-term-care needs of the growing numbers of aging tribal members are largely ignored. John (1991) points out that an additional problem confronting tribal elders is a policy of age discrimination in resource allocation within the IHS. Specifically, he notes that the IHS concentrates its resources on the health problems of younger tribal members through the Resource Allocation Method, which is based on a calculation of