Nursing homes serving black residents have fewer resources for care, study finds

Nursing homes with high concentrations of black residents tend to struggle financially and provide lower-quality care than facilities with no black residents, according to a study recently published by the journal Health Services Research.

"There is no simple fix. It is a complex issue, but we need to address it, because disparities are everyone's issue,” says University of Central Florida Assistant Professor Latarsha Chisholm, MSW, PhD, who conducted the study with colleagues.

Potential solutions to mitigate racial and ethnic disparities in nursing homes, she adds, include providing financial incentives to facilities that improve performance and restructuring Medicaid to provide better reimbursement rates. The Affordable Care Act may do little to remedy healthcare disparities found in long-term care settings, Chisholm says, but it may provide better continuity of care earlier in life so that those entering nursing homes later have fewer or less costly health issues as they age.

Chisholm and colleagues obtained and analyzed financial and quality data related to more than 11,500 nursing homes nationwide from 1999 to 2004. Previous studies had used percent Medicaid as a proxy for financial performance, but their study used actual financial performance measures, such as total profit and operating margin.

Racial and ethnic disparities in healthcare settings, according to Chisholm, exist for many reasons:

• Black residents are concentrated in Medicaid-reliant nursing homes.
• Residential segregation and admission practices exist.
• Black people tend to choose nursing homes close to where they live, and these facilities may serve mostly black residents covered by Medicaid.
• Nursing homes with a high proportion of black residents may encounter financial challenges to invest in staffing and staff training, which can influence racial and ethnic disparities in care.
• Statistically, black people rely on Medicaid more than non-black people do to pay for nursing home needs, so nursing homes that care for them receive lower reimbursement and therefore have fewer resources to provide quality care to residents.

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Lois Bowers

Lois A. Bowers was senior editor of I Advance Senior Care / Long-Term Living from 2013-2015.