Report: Blacks Receive Unequal Nursing-Home Care
By Kathleen Fackelmann,
A new report reveals a system of separate and unequal nursing-home care for black Americans, one that could expose frail seniors to substandard care.
The study, out in the September/October issue of Health Affairs, finds that 60% of blacks in nursing homes ended up in just 10% of the facilities — typically ones that had been cited for quality problems.
"The nursing-home industry is still quite segregated," says researcher David Barton Smith of Temple University in Philadelphia. "There are homes for blacks and homes for whites."
His study of 7,196 nursing homes in 147 metropolitan areas throughout the USA is one of the first to document a troubling trend in care provided to black Americans.
"It is time to air the dirty laundry" about the problem, Smith says.
Nursing homes may simply reflect the racial composition of the neighborhood, he says. Blacks who live in the inner city tend to go to nearby facilities, which also may have mostly black patients covered by Medicaid, the federal health insurance program for the poor.
Medicaid payments don't sufficiently cover the cost of providing services to most residents, says Alan Rosenbloom, president of the Alliance for Quality Nursing Home Care, a group representing for-profit nursing home chains.
Homes that rely heavily on Medicaid are more likely to cut staff to the bone, and that can result in shoddy care, Smith says.
The analysis in Health Affairs also found that:
_Blacks were nearly three times as likely as whites to be in nursing homes that predominantly cared for Medicaid patients.
_Blacks were twice as likely to be located in homes that had provided such poor care that they were subsequently kicked out of Medicaid and Medicare.
_Blacks were nearly 1½ times as likely as whites to be in homes that had been cited for deficiencies that could cause immediate harm.
The study also found that nursing homes in the Midwest were most likely to be racially segregated. Nursing homes in the South were the least likely to have an unequal distribution of minorities.
Hospital-discharge planners may steer blacks to just a few facilities known to accept Medicaid patients right away, Smith says. Inner-city hospitals are under tremendous pressure to discharge patients quickly — often to the first easily available bed, he says.
"This study reflects disparities in the quality of care for African-American seniors, and that is simply wrong," Rosenbloom says.
He and Smith agree that one way to address the problem would be to increase Medicaid payments to facilities struggling to care for lots of impoverished patients.
In addition, families don't have to accept the hospital's recommendation for a nursing home, especially if the home is short on staff or has other quality problems.
"Just say no — 'I don't want my mother to go to that nursing home,' " Smith says.
I know that all of us have someone in our lives that, someday, this might be an issue. I don't want any of my relatives to go into a nursing home. I just don't think that they are any good, and articles like this one, and the one below just reinforce my opinion.
It shouldn't be a surprise that racism would follow our elders into nursing care; after all, it has been an issue all of their lives, and the disparity of value of our lives has been present since day one. And, while studies like this are discouraging and maddening, they are also valuable because they validate what we've long suspected , but been told that we ' imagined'. Since certain folk can only believe stats on a piece of paper, well, here they are.