Race-based discrimination has always been a significant problem which still occurs today. Dealing with it in the workplace can be stressful, frustrating, and even highly emotional depending on how it has transpired. Certified nursing assistants (CNAs) are trained to deal with discrimination in a specific way. If CNAs are the ones being victimized, they are taught to remain courteous and to remind themselves that sometimes people are brought up in environments that foster racism. However, this approach does not condone the belief. Sometimes the tables are turned, and patients, too, can be mistreated in a facility. It is a pervasive problem with damaging effects. The purpose of this study is to examine if race discrimination has increased or decreased over the years and to determine the effect it has had on health care. The research question is as follows: How has discrimination and racism between long-term care patients and CNAs changed in health care from previous years to now?
Variables and Their Definitions
The outcome measure variable for this paper is discrimination. The group variable features health care professionals and long-term care patients. The independent measure is race.

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Race discrimination is defined as discriminatory or abusive conduct towards affiliates of another race. In 1964, Title VII of the Civil Rights Act put a ban on workplace discrimination. Regardless of this commandment, racial issues continuously take place in some long-term care facilities where care-seekers decline care from a health care professional of a different race. The 2010 case Chaney V. Plainfield Healthcare Center offers an example of such a scenario. There was an issue of how the employer informed a black CNA that her long-term care patient preferred to not have black CNAs. This highlights a grey area in the law between Title VII and the Reform Act, which ensures that health care professionals don’t have to suffer the indignity of discrimination by a long-term care patient. Although discrimination and racism continue to be a part of American society, the American Nurses Association (ANA) is continuing to work on the abolition of it. They work to promote justice in health care for all people, including patients and CNAs themselves. Long-term care is a range of services and supports needed to meet personal care requirements. Long-term care patients are the most important people in that type of environment, because they are the ones in the greatest need of care. However, they also struggle ith racial issues and can face discrimination at times. With the establishment and enforcement of certain laws, discrimination and race issues have been reduced, but to completely get rid of those variables is nearly impossible. There will almost always be concerns regarding equality, but if the goal is to lessen the number of incidences then the goal would be more likely to be accomplished.

Literature Review
The literature regarding this topic features both quantitative and qualitative approaches to the issue. In the six studies examined for this review, the issue was primarily studied from the point of view of the CNAs – their experiences of race and discrimination. This suggests two possibilities. The first is that patients are not experiencing or reporting racism or discrimination at the hands of CNAs. The second is that this is a significant gap in the literature, and this facet of the issue needs closer examination. Regardless, what does emerge from the literature regarding CNAs and discrimination is a sense that racism unsurprisingly continues to occur, especially towards CNAs of color (Abrahamson et al., 2011; Fisher & Wallhagen, 2008; Gronningsater, 2012; Ramirez, Teresi, & Holmes, 2006; Ryosho, 2011). Another dimension of racism and discrimination which emerges is the increasing number of immigrants filling CNA positions (Fisher & Wallhagen, 2008; Massey, 2013; Ryosho, 2011). However, it appears that racism is on the decline, with cultural factors being more involved than race-related factors (Fisher & Wallhagen, 2008; Massey, 2013; Ryosho, 2011). Xenophobia rather than racism appears to be increasing (Massey, 2013). Gender appears to be a potential element in discrimination against CNAs though less so than race or cultural elements (Ryosho, 2011).

One of the complicated features of racism and discrimination in long-term care facilities with regard to patients is the importance of maintaining patient-centered care, respecting the patient’s preferences and autonomy while protecting employees from workplace hostility (Gronningsater, 2012). This is a difficult balance, given both legal and ethical considerations, since certain laws like the Civil Rights Act are in place. Legally speaking, the preferences of the patients (that is, requesting that CNAs of other races not see to the patient’s care) would be considered significant discrimination and should not be accommodated. However, providing person-centered care that provides an environment in which the patient is comfortable cannot be ignored (Gronningsater, 2012).

The reasons for the apparent decline of racism and discrimination in long-term care facilities are attributed to increasing racial and cultural diversity in the American population (Fisher & Wallhagen, 2008) and cultural diversity/competency training for both residents and staff of long-term care facilities (Fisher & Wallhagen, 2008; Gronningsater, 2012; Ryosho, 2011). The need for cultural diversity/competency training for both residents and staff of such facilities is emphasized in several of the studies as a means of mitigating or reducing racism and discrimination (Fisher & Wallhagen, 2008; Gronningsater, 2012; Ryosho, 2011).

Theory: Functionalism (Structural Functionalism)
The theory selected for this research is functionalism, also known as structural functionalism. This perspective attempts to express how the different facets of a society and the interrelationship of those facets using an organic analogy where those different facets are equated “to the organs of a living organism” which is “able to live, reproduce and function through the organized system of its several parts and organs” (Porth, Neutzling, & Edwards, 2009). The focus of functionalism is to examine the social significance of processes and phenomena to understand the function(s) these processes and phenomena serve in the society in which they occur and how they “serve a particular society in maintaining the whole” (Porth, Neutzling, & Edwards, 2009). Malinowski, one of the most significant theorists related to functionalism, asserted that people have physiological needs such as food, shelter, and reproduction, and that the meeting of those needs gives rise to social institutions that meet those needs (Porth, Neutzling, & Edwards, 2009). This aspect of functionalism explains the need for long-term care facilities and the presence of CNAs in those facilities. It also attempts to understand the existence of racism and discrimination in those facilities and the ways in which those events affect or function in the institution and the individuals served by and those who serve in that institution.

Due to the fact that there have not been any previous court cases pertaining to race discrimination in health care and it has become less of an issue, the answer to the question above is that it has decreased over the years. With the efforts of the ANA and the establishment and enforcement of the Reform Act, discrimination and racial matters have reduced quite a bit. This is not to say that such problems never occur. However, when it does occur the field becomes more and more aware of it, and solutions are created to continuously decrease the issue at hand. Overall, the effect discrimination and race have had on health care is positive. It has pushed society to progress and to handle these situations professionally and more tactfully.

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