Samuel: resident-to-staff racism in adult social care
Setting: Adult social care: care home setting.
Context
Samuel is a 42-year-old Black British senior care assistant of Afro-Caribbean heritage. He has worked in adult social care for more than ten years and is respected by residents, families and colleagues for his compassionate and professional approach. Margaret is an 84-year-old White British resident living with early-stage vascular dementia, diabetes and reduced mobility. She requires support with medication, personal care, nutrition and emotional wellbeing.
What happened
Samuel is one of the regular carers assigned to Margaret’s care plan. When he first begins supporting her, Margaret appears polite but distant. Over time, her behaviour becomes increasingly discriminatory. She refuses personal care from Samuel, says she wants “an English carer instead” and repeatedly refers to Samuel as “boy” rather than by his name. Some colleagues overhear these remarks but initially dismiss them as “just her generation” or related to dementia. Samuel attempts to remain professional and continues delivering care respectfully.
Over several weeks, the behaviour escalates. Margaret begins refusing meals and medication when Samuel is on shift. She shouts racial slurs during personal care and makes complaints to management demanding that Samuel be removed from her care. Samuel becomes distressed and emotionally exhausted. To protect his wellbeing, he starts avoiding unnecessary interaction with Margaret. Other staff begin informally swapping duties to avoid conflict, leading to inconsistency in Margaret’s care routine.
Management initially responds by rotating staff assignments and advising Samuel not to “take it personally”, while also explaining the behaviour as part of Margaret’s dementia. No formal risk assessment is completed, no anti-discrimination procedure is initiated and no structured support is offered to Samuel. The wider impact on care quality is not addressed.
Impact
Samuel feels unsupported and isolated. Care arrangements become inconsistent. Margaret misses medication doses due to refusal and confusion about carers, blood sugar monitoring becomes irregular and communication between staff and Margaret deteriorates.
Margaret later falls while trying to mobilise independently and is admitted to hospital with a fractured hip. Hospital staff identify dehydration, poor diabetic control and missed medication doses as contributing to her deterioration.
Samuel takes sick leave due to work-related stress. Team morale declines and staff begin to feel discriminatory behaviour is tolerated within the home.
What anti-racist practice should look like
Cognitive impairment may influence behaviour, but it does not remove the organisation’s responsibility to recognise racism, assess risk and protect staff dignity. A compassionate and structured response should balance person-centred care with staff safety, continuity of care and anti-discriminatory practice.
Key learning points
- Racism towards staff should never be normalised, minimised or dismissed
- Staff have the right to work in a culturally safe and respectful environment
- Dementia-informed care and anti-racist practice must work together
- Discriminatory behaviour can disrupt continuity of care and affect safety, communication and treatment adherence
- Managers should complete risk assessments, document concerns, review care plans and offer staff support
- Organisational inaction can harm both staff wellbeing and resident outcomes
- Clear policies should include guidance on patient, resident and family racism towards staff
- Early intervention protects dignity, safety, morale and quality of care.
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