Blacks are more likely than whites to be located in nursing homes that have serious deficiencies, lower staffing ratios and greater financial vulnerability, according to a new study in the September-October issue of Health Affairs. Researchers measured nursing-home segregation based on the 14,374 free-standing nursing homes in the year 2000 and the 1.46 million residents they served, which accounted for 88% of all U.S. nursing-home facilities and 89% of nursing-home residents that year.
The study, sponsored by the Commonwealth Fund, found that blacks were 2.64 times as likely than whites to be in a facility that housed predominantly Medicaid residents, and 1.12 times likelier than whites to be in a facility that was greatly understaffed relative to the acuity profile of the residents.
Nursing homes remain relatively segregated, roughly mirroring the residential segregation within metropolitan areas, the study said. Ranking metropolitan statistical areas based on disparities between blacks and whites in access to quality nursing homes, researchers found that 10 of the 20 nursing homes with the greatest disparities of care were in Indiana, Ohio, Michigan and Wisconsin.
Acknowledging that it will take a long time to fix these problems, lead author David Smith, professor emeritus at Temple University, suggested some ideas for more immediate improvement. These include targeted consumer education to inform consumers about their choices and hospitals about what Smith called their quality-of-care obligations and civil-rights obligations to patients and families, greater provider accountability, and certificate-of-need laws that guide development to ensure that expanding beds and building new facilities fit the needs of a region. -- by Jessica Zigmond
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