Across the United States, Black nurse aides working in long-term care facilities say there’s one pattern they encounter repeatedly when caring for patients with dementia and Alzheimer’s disease: while memory loss may erase names, birthdays and even decades of life events, racist language and beliefs often remain intact.
Certified nursing assistants (CNAs) and home health aides — many of whom are women of color — form the backbone of elder care. According to data from the U.S. Bureau of Labor Statistics, nursing assistants are among the fastest-growing occupations in the country, with Black women disproportionately represented in the workforce. In dementia units especially, aides spend the most time with residents — bathing, feeding, repositioning and providing daily emotional support.
Several Black aides interviewed for this story described being called racial slurs by residents who could not recall their own children’s names minutes later.
“You’ll have a resident who doesn’t know what year it is, who can’t remember breakfast, but will look at you and use a word you know they learned decades ago,” said one Maryland-based CNA who requested anonymity due to workplace concerns. “It’s like the prejudice is etched deeper than the memories.”
Medical experts say dementia does not create racism — but it can remove social filters. According to the Alzheimer’s Association, Alzheimer’s disease progressively damages parts of the brain responsible for memory, reasoning and impulse control. As cognitive decline worsens, individuals may lose the ability to regulate speech or behavior.
Dr. Monique Green, a geriatric behavioral specialist, explains that dementia can strip away learned social restraints. “If someone held prejudiced beliefs earlier in life — even if they learned to suppress them — dementia can reduce inhibition. What comes out is often what was deeply embedded over a lifetime.”
Black aides say the impact is both emotional and complex. Many understand the neurological explanation. But understanding does not eliminate harm.
“There’s a difference between knowing it’s the disease and feeling it in your body when someone spits a slur at you,” said another aide who works in a Midwestern memory-care unit. “We are trained to show compassion. But compassion doesn’t make you immune.”
The issue exposes broader structural realities in elder care. Long-term care facilities are racially diverse on the staffing side, but many older patients came of age during segregation, Jim Crow laws and legally enforced racial discrimination. For some aides, dementia units become a collision point between generations shaped by starkly different racial climates.
The Centers for Disease Control and Prevention reports that Alzheimer’s disease is one of the leading causes of death among older adults in the U.S., and cases are expected to rise sharply as the population ages. At the same time, workforce shortages in nursing homes have intensified pressures on aides, who already face high burnout rates and relatively low wages.
Experts in geriatric psychology emphasize that facilities should better prepare staff to navigate racially charged incidents. Some institutions provide de-escalation training, counseling access and protocols for reassignment when abuse becomes severe. But aides say support is inconsistent.
“There are days when you remind yourself: this person is sick,” one aide said. “And there are days when it just feels like history repeating itself in a hospital bed.”
Researchers caution against oversimplifying the phenomenon. Not every patient with dementia exhibits racist behavior. Some become affectionate, childlike or withdrawn. Others display paranoia or aggression unrelated to race. Dementia manifests differently in every individual.
Still, for many Black nurse aides, the experience underscores an uncomfortable truth: cognitive decline may dismantle memory, but it often leaves behind the social imprints formed over decades.
As one aide put it, “They forget everything else. But what they were taught about us? That’s still there.”
With Alzheimer’s diagnoses projected to climb in the coming decades, advocates say the conversation must include not only patient dignity, but also caregiver protection — particularly for workers of color who carry both the labor and, at times, the emotional weight of America’s unfinished racial history.
