August 16th, 2023

Study finds racial disparities in U.S. nursing homes

Quality-of-care issues result In higher hospitalization rates

A new study has found that, nationwide, nursing homes with a majority of Black residents tend to see higher levels of hospitalizations and emergency department visits and are more likely to employ less-qualified nursing staff.

Jasmine Travers, a professor of nursing at New York University and one of the co-authors of the study published in June said much of the data verified what researchers in the field already suspected.

“We know there’s disparities in care, and it’s kind of like, ‘All right, let’s do this research and see what we find,’” Travers said. “It was just kind of validating the things we hypothesized and suspected.”

The study found that nursing homes with more than 50% Black residents were more likely to have fewer registered nurses and certified nursing assistants and more licensed practical nurses, who aren’t qualified to make the same level of decisions about patient care. The study also found that majority-Black nursing homes tend to be for-profit and have a larger proportion of residents on Medicaid, both characteristics associated with poorer care.

The disparity in staffing can lead to greater hospitalizations of nursing home residents, Travers said.

“RNs have this critical thinking. They’re trained to assess the resident. They’re trained to look at the resident and see what’s going on and kind of create a story, where they then communicate that story to the primary care provider,” she said.

Without that assessment, a licensed practical nurse might instead just have to send a resident to the hospital, which increases health care costs and complicates resident care.

“You go to the hospital, and it’s learning what medications are [the resident] on, getting their medications that they’re supposed to be on, ensuring they’re able to get their medications consistently — so it’s just that fragmentation of care that is a risk when going into the hospital,” Travers explained.

The findings from Travers’ study fit into a broader picture of racial disparities in Massachusetts, said Carolyn Villers, executive director of the Massachusetts Senior Action Council.

“Unfortunately, we can really look at systemic racism, not just in terms of where people are placed, but also the types of care offered to people in nursing homes,” she said.

Villers said when it comes to racial disparities, Massachusetts nursing homes face issues around infection rates, social opportunities and treatment generally, like who is fed with a feeding tube.

There is also increased staff turnover in nursing homes that serve mostly residents of color, she said.

“Lower wages and less training and room for development leads to higher turnover rates, and often facilities that have higher proportions of BIPOC community fall into that,” Villers said.

The study also found that higher percentages of Black residents in nursing homes tended to correspond to a higher proportion of Medicaid residents. It found that nursing homes with a majority of Black residents on average had almost 75% of residents on Medicaid. In nursing homes overall, just over 50% of residents on average were paying with Medicaid.

“That also leads to poorer quality of care,” Travers said.

Villers said that the lower level of care often comes down to Medicaid reimbursement rates. A nursing home serving a resident on Medicaid only receives a portion of the amount a resident would pay out of pocket.

According to the American Health Care Association’s National Center for Assisted Living, as of 2020, Medicaid reimbursements cover only 70% to 80% of the actual cost of nursing home care.

Villers said that disparities in nursing homes, like those identified in Travers’ study, don’t exist in isolation.

“The nursing home disparities tie back into health disparities, which tie back into housing disparities,” she said. “All of these systems are closely connected.”

nursing homes, racial disparity