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Study: Blacks More Likely than Whites to Live in Poor-Quality Nursing Homes

By Mary Agnes Carey, CQ HealthBeat Associate Editor

September 11, 2007 – Blacks are more likely than whites to live in poor-quality nursing homes across the United States, according to a new report in the journal Health Affairs.

Researchers found that 10 of the 20 nursing homes with the greatest disparities in quality of care were located in Wisconsin, Indiana, Ohio, and Michigan. Milwaukee is noted as the metropolitan area with the greatest disparity in care, with blacks who reside there more than twice as likely as whites to live in a nursing home with significant inspection deficiencies, substantial staffing shortages, and financial problems.

The study also showed that care inequalities are closely correlated to racial segregation. Researchers found that nursing homes in the Cleveland metropolitan area were the most segregated, followed closely by Gary, Ind., Milwaukee, Detroit, Indianapolis, Chicago, St. Louis, Harrisburg, Pa., Toledo, Ohio, and Cincinnati.

The report, billed as the first to document the relationship between racial segregation and quality disparities in U.S. nursing homes, was paid for by The Commonwealth Fund and written by researchers at Brown University.and Temple University. The study, which used 2000 data, examined racial segregation in 147 metropolitan statistical areas, with 7,196 nursing homes caring for more than 800,000 residents.

Policy changes that could improve the quality of nursing homes and potentially eliminate disparities identified in the study include improving payments to nursing homes with a high proportion of Medicaid residents, closing the gap between the amount paid to nursing homes by Medicaid and private payers, as well as broader regional planning in response to concerns about racial disparities, researchers found.

Researchers also found that nursing homes in the South were the least likely to have unequal racial distribution of residents relative to residential racial composition. Only four Southern urban centers—Houston, West Palm Beach, Fla., Richmond, Va., and Winston-Salem, N.C. —landed in the top 20 metropolitan area with the highest level of racial disparities in nursing home quality.

"Blacks and whites aren't getting different care in the same nursing homes. They're getting different care because they live in different nursing homes," said Vincent Mor, chairman of the Department of Community Health at Brown University and the study's lead investigator. "In the same urban areas, blacks are more likely to be concentrated in substandard nursing homes—homes with smaller budgets, smaller staffs, and poorer regulatory performance."

Other findings in the report include:

  • Blacks were nearly three times as likely as whites to be located in a nursing home housing predominantly Medicaid residents.
  • Blacks were nearly twice as likely as whites to be located in a nursing home that was subsequently terminated from Medicare and Medicaid participation because of poor quality.
  • Blacks were 1.41 times as likely as whites to be in a nursing home that has been cited with a deficiency causing actual harm or immediate jeopardy to residents. Blacks were also 1.12 times as likely as whites to live in a nursing home that was greatly understaffed.

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