Black Nursing Home Residents Hospitalized More Often Than Whites
Although African-Americans make up only 11 percent of the nursing home population, they tend to be cared for in homes that serve a much higher percentage of African-Americans residents and end up in the hospital more often than white residents do, according to a new study of more than one-half million residents in nearly 9,000 U.S. nursing homes.
"This sort of segregation across facilities is of concern because it seems to be strongly associated with measures of resource availability," said Andrea Gruneir, lead study author. "In other words, black residents are more likely than white residents to be cared for in nursing homes that appear to have access to fewer resources."
Gruneir and former colleagues at Brown University looked at nursing homes in urban areas with at least 20 beds. The nursing home residents were assessed during a 150-day period in 2000 and those who were included in the study were all long-stay (more than 90 days) and over age 65, for a total of 516,082 residents.
The study appears in online and in the latest issue of the journal Health Services Research.
Using Medicare data to identify how many residents underwent hospitalization during the study period, the authors found that 18.5 percent of white and 24.1 percent of African-American residents had a hospital stay. Residents who lived in nursing homes with high concentrations of African-American residents had 20 percent higher odds of hospitalization than residents did in homes with no African-Americans.
The study also examined average per-day Medicaid reimbursement rates and found there was a link between hospitalization and Medicaid payments. Higher Medicaid payments reduced the risk of hospitalization significantly more for African-Americans (22 percent) than for whites (4 percent) in the nursing homes.
The study deemed nursing homes that were more dependent on Medicaid payments rather than private pay to be of lower quality based on staffing and facility organization.
"We were particularly interested in any role that Medicaid reimbursement policies might play because they are the predominant payer of nursing home services in the U.S. and their policies are clearly linked to quality outcomes," said Gruneir, currently a postdoctoral fellow at the Kunin Lunenfeld Applied Research Unit, Baycrest Centre in Toronto. "We believe that this sort of research is the first step in identifying the kinds of policy and system changes needed to ensure equity for all nursing home residents."
Bruce Yarwood, president and CEO of the American Health Care Association (AHCA), agreed, "Socioeconomic factors contribute to disparities in our health care system." AHCA is a nonprofit federation that represents assisted living, nursing facility and subacute care providers nationwide.
"Providing quality nursing home care to higher-acuity patients is a difficult task and one that is made more challenging by the national nursing shortage, Medicaid's $4.5 billion under-funding of long-term care and proposed cuts to Medicare's fiscal year 2008 cost-of-living adjustment for skilled nursing care," Yarwood said. "In fact, two-thirds of nursing home residents rely on Medicaid to pay for the care they need, for which nursing home providers are reimbursed on average $13.10 per patient per day less than the cost of providing that care."