Male nurse consulting with senior female patient and adult daughter in exam room
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Integrating diversity, equity and inclusion into a long-term care company culture is a journey, and that journey still has a long way to go, according to National Center for Assisted Living Executive Director LaShuan Bethea.

LaShuan Bethea headshot
LaShuan Bethea, J.D., M.Ed., BSN, RN

Bethea spoke Thursday during a webinar presented by the Center for Excellence in Assisted Living and the Advancing Excellence in Long-Term Care Collaborative.

Workplace diversity training, Bethea said, emerged in the 1960s through the passage of several federal laws, including the Equal Pay Act, Title VII of the Civil Rights Act and the Age Discrimination in Employment Act. Fortune 500 companies focused on diversity compliance between 1970 and 1990, she said.

Over time, the concept of DEI in the workplace evolved, Bethea said. “From 1990 to 2000, consumer brands saw value in a diverse workforce, and academic research began to study inclusion, which became a primary focus between 2000 and 2015. Since then, she added, equity has made its way into the discussion.


Diversity, she said, introduces the concept of thinking about others beyond oneself and identifying who is not at the table. Workplace decision-makers, she said, must consider who their decisions will affect and whether the options reflect the best interests of the decision-makers or those affected by those decisions. 

Organizationally, Bethea encouraged employers to look at committees and workgroups that set policies and procedures to determine whether those decision-makers reflect the diversity of the workforce. Hiring practices also should incorporate methods to ensure a diverse candidate pool for employment decisions, she said.


Equality, Bethea said, equates to sameness — giving everyone the same thing — whereas equity is offering fairness and access to the same opportunities.

“There are opportunities for equity around social factors and an individual’s skills, as well as an employee’s physical abilities,” she said, adding that it’s important for leaders to evaluate the strengths and weaknesses of each employee. “The goal is to create an environment that meets employees where they are by positioning people to minimize or strengthen their weaknesses and allow[ing] people to lead with their strengths.”

Organizations should reflect on whether they incorporate individual employee goals or solely focus on company goals or a one-size-fits-all approach, Bethea said.


The concept of inclusion, in addition to meaning creating a work environment where all individuals are treated fairly, impartially and respectfully, means providing access to opportunities and resources.

“The key to inclusion is not just that you are present and have a seat at the table, but you are able to contribute while you are at the table,” Bethea said. “Merely having a seat at the table doesn’t necessarily mean there is inclusion if the environment is not one where people feel comfortable raising their issues, concerns or ideas.”

Inclusive leaders

Everyone goes through a process in developing a full understanding of DEI, which begins with an individual’s perspective based on known experiences and beliefs, Bethea said. The journey to becoming an inclusive leader, she added, involves these steps:

  • Unaware: Going along with DEI-related tasks to be compliant.
  • Aware: Understanding the advantages and disadvantages, and making an effort to learn more.
  • Action: Taking active steps to create DEI opportunities, and supporting others in the journey.
  • Advocate: Actively working to bring systemic change, and being a strong advocate within and outside an organization.

Bethea also encouraged leaders to be aware of unconscious biases — attitudes or stereotypes that affect someone’s understanding, actions and decisions — in employment decisions and perceptions of employees.