African-Americans More Likely Than Whites To Receive Inadequate Nursing Home Care, Study Finds

African-American seniors are four times more likely than white seniors to live in "understaffed and poorly funded nursing homes that offer substandard care," according to a study funded by the Robert Wood Johnson Foundation and published in the Milbank Quarterly, the Washington Post reports (Hull, Washington Post, 6/21). In the study, researchers from Brown and Temple universities examined records from more than 14,000 nursing homes nationwide in 2000. They identified "an enduring two-tiered system of nursing home care," the Providence Journal reports. Lower-tier facilities were defined as having 85% or more residents covered by Medicaid (Freyer, Providence Journal, 6/21). Further, lower-tier facilities have difficulty retaining staff members, have few financial resources and often restrain patients, according to the Post (Washington Post, 6/21). The study found that 40% of African-American nursing home residents nationwide reside in lower-tier homes, compared with 9% of white nursing home residents. The 30-page report said that the trend is true in almost every state in the nation -- with some of the "worst records" in Louisiana, Mississippi and Georgia, the San Francisco Chronicle reports (Johnson, San Francisco Chronicle, 6/21). According to Vincent Mor, the study's lead author and a professor of medical science at Brown, about 15% of nursing homes qualify in the lower tier. Mor said that the disparity in nursing-home services results from both economic conditions and geographic segregation (Providence Journal, 6/21). He added, "It becomes a vicious cycle. Nursing homes are local. ... In a poor neighborhood, you can't attract richer people, so only poor people come to the nursing home. You have a harder time paying staff and you have a higher turnover rate. Care becomes substandard." Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging, said "Middle- and upper-income people are seeing more options in terms of continuing care retirement communities and assisted living. ... But the poor, sick and old are winding up in the nursing homes similar to those 'low-tier' facilities described in this report."

The study also indicates that an initiative to issue quality ratings for nursing homes and post the results on a Web site launched by CMS last year is "having some unintended consequences," the Post reports. The idea behind the effort was that by rewarding top performers with bonuses, the standard for overall services would increase. However, the study says that because many nursing homes with low scores do not have the funds to compete, they are not able to increase their level of care enough to reach higher scores. As a result, such facilities are vulnerable to closing "or worse" -- continuing to offer substandard care to residents with the least means to take care of themselves, the Post reports (Washington Post, 6/21). Mor said, "Competition works only in markets where consumers have choices, and unfortunately, many of these nursing home residents don't have much choice." He added, "Closing substandard homes will take away all their alternatives without giving them any new ones" (Providence Journal, 6/21).

To reduce inequalities in nursing homes nationwide, the study suggests:

• Increasing Medicaid payments so that lower tier facilities have more financial resources;
  


• Offering training programs for nursing home managers to learn how to improve quality (San Francisco Chronicle, 6/21);
  


• Having states monitor on a more frequent basis than annual inspections facilities with high concentrations of Medicaid beneficiaries (Washington Post, 6/21);
  


• Giving state and city governments the authority to take over apparently failing nursing homes; and
  


• Creating a risk pool to relocate lower-tier home residents to other facilities if the nursing homes in which they reside are going to close (San Francisco Chronicle, 6/21).