If Martin Luther King, Jr. was alive today, he would be 86. If he was like many elderly black Americans, he might well end up in a nursing home ranked lower in quality and with less well-trained nursing staff than a nursing home that many white Americans reside in. The facility would likely house a disproportionately larger proportion of people of color and on Medicaid than higher-quality nursing homes.
The disparities are easy to miss. After all, what happens in nursing homes stays in nursing homes, invisible to the rest of us. The only ones who see what’s going on are the patients, family and friends, and staff. If people report lousy conditions in the homes, nursing homes often vilify them. In fact, some would argue that the industry hides behind a smokescreen of patient privacy. Yes, there are inspections. Are they sufficient to drive equal care? Apparently not. Overall, the nursing home industry has changed little in terms of providing quality care for minority elders on par with what white elders get.
Documentation of inequality in long term care for minority elders dates back to enactment of Title VI of the Civil Rights Act and the passage of Medicare in 1966, which prohibited segregation in health facilities that accepted federal funds. In 1981, an Institute of Medicine report addressed the issue of segregated care in nursing homes. The hospital industry was forced to integrate to some degree at least, but nursing homes have been left largely alone.
Contrary to stereotypes, a large Commonwealth Fund analysis led by Vincent Mor, PhD, from the Department of Community Health at Brown University, found that segregation was lowest in the South and highest in the Midwest (Wisconsin, Missouri, Michigan, Indiana, and Ohio). The study found that Cleveland, Ohio, followed closely by Gary, Indiana, were the most segregated cities for nursing homes. Additionally, black elders tended to be in nursing homes in the lowest quarter of quality ratings. Blacks were 1.7 times as likely as white Americans to reside in a nursing home that was subsequently thrown out of the Medicare and Medicaid programs because of poor quality and 2.64 times as likely to be in a facility housing predominantly Medicaid residents. Elderly black Americans are not the only groups at increased risk of going to a poor-quality nursing home. So are elderly Hispanics and probably many other groups not cited here.
The proliferation of for-profit nursing homes in an industry that was once largely nonprofit has also had adverse impacts. In this study, for-profit nursing homes have been found to have lower RN staff intensity and lower RN skill mix than nonprofits, jeopardizing patient care. Poor people on Medicaid are going to for-profit nursing homes at far greater rates in many parts of the country.
This post is a snapshot of one part of long term care, which is an immense, complex topic.
Readers would be misguided if they thought that disparities are concentrated in the Midwest and do not persist elsewhere. These two anecdotes, though not data, are telling. Friends of mine recently watched in tears as a dear African American male friend landed for a long stay in a one-star nursing home in New Jersey. The nursing home housed people of color on Medicaid primarily. My friends were inconsolable when they returned from a visit, quick to call it a “crowded, smelly, dumping ground.” I learned of another story from an older African American woman from Queens NY, a New York City government retiree. I worked with her for many years. When she felt that she could no longer keep up her house, she could not find a satisfactory long term care residence to move into. She never left home: her health deteriorated and eventually, she died at home.
These stark realities are shameful. It’s 2015. We can quibble about statistics, question cause,effect, or association, but outrage, remedies, and stiff penalties and incentives for change are desperately needed.
This is interesting, though not astonishing. Most surprising, however, is that the South is the least segregated. I wonder how that came to be.
Bravo! This is a time where race is becoming a more open subject. After killings, we now advance to this subject of nursing homes.
I was horrified to see the physical facilities and lack of staff at a for profit nursing home in New Jersey. The residents are mostly middle-aged people of color who are wheelchair-bound. It feels like either their families are not involved, or they accept this is the best they’ll get. Race and income level matter, through every life stage.
No big mystery why Southern nursing homes are the least segregated. That’s where Title VI was originally enforced. I was a federal agent in 1966, charged with helping desegregate medical facilities in Mississippi. Dozens of us were sent to Southern states, since that’s where the Dept. of HEW (now HHS) assumed the worst conditions to be. That may have been correct, but included the assumption that places outside the South were adequately integrated. Wrong.
No mystery why Southern nursing homes are the least segregated. That’s where Title VI was most strenuously enforced. In 1966 I served as a federal agent in Mississippi, charged with desegregating medical facilities. The Dept. of HEW (now HHS) sent dozens of us into Southern states in particular, under the assumption that that’s where segregation was most common. That may have been true, but it ignored the situation in other states.
That’s fascinating.I wondered how that occurred. I would love to hear more.
Is the term “people of color” acceptable in the US? It’s not really in the UK, its a bit cringe-worthy for me reading it here but may be a UK US difference i’m not aware of. It stuck out for me so thought i’d ask.
I suspect that this is a UK/US difference. However, I think that the mainstream press is perhaps less likely to use it, instead sticking to naming specific groups. Surely, the word “colored” was rejected long ago in the US. However, a quick Google search will show you that left groups, those interested in diversity and inclusion are using it more and more. That said, racial/ethnic categories are highly controversial and the Centers for Disease Control and Prevention is currently reconsidering its taxonomy.