State surveyors use Federal nursing home certification regulations to evaluate the quality of nursing homes and identify deficiencies ranging from inadequate staffing to overuse of restraints. Blacks are disproportionately admitted to low quality nursing homes with a high number of deficiencies, according to a recent study conducted by David C. Grabowski, Ph.D., at the Agency for Healthcare Research and Quality Center for Cost and Financing Studies Data Center. He found that, after controlling for resident and home characteristics, blacks were admitted to nursing homes with 44 percent more deficiencies than whites. Hispanics were admitted to homes with 43 percent more deficiencies than whites, and individuals of other races were admitted to homes with 35 percent more deficiencies. Also, 41 percent of black nursing home admissions had Medicaid as the primary payer compared with 23 percent of white admissions.
Policies that address broader geographic disparities in resources, such as improvements in Medicaid funding (shown to improve quality), could help address racial disparities in quality of care, suggests Dr. Grabowski. He analyzed data from the 1996 Medical Expenditure Panel Survey (MEPS) Nursing Home Component (NHC), a survey of nursing homes and people residing in or admitted to nursing homes during 1996. This study examined the quality of care for 2,690 new admissions to 815 nursing homes during that year.
Whites were, on average, admitted to nursing homes with 5.13 deficiencies, blacks to homes with 7.39 deficiencies, Hispanics to homes with 7.33 deficiencies, and individuals of other races to homes with 6.94 deficiencies. The underlying source of this difference is unclear, but it could relate to broader disparities in resources across communities, discriminatory practices on the part of the facilities, and/or lack of choices and quality-related information available to minority elders.
See "The admission of blacks to high-deficiency nursing homes," by Dr. Grabowski, in the May 2004 Medical Care 42(5), pp. 456-464.
Editor's Note: Another AHRQ-supported study on a related topic suggests that broadcast media, an important information source for minorities and the less educated, be used to inform these vulnerable groups about health issues, since they are less likely to have access to online health education via the Internet. For more details, see Cashen, M.S., Dykes, P., and Gerber, B. (2004). "eHealth technology and Internet resources: Barriers for vulnerable populations." (AHRQ grant HS11092). Journal of Cardiovascular Nursing 19(3), pp. 209-214.