Do Black New York Seniors Receive Worse Nursing Home Care?

A new study from researchers out of Rochester, New York took a look at quality of care trends from 11,500 nursing home and compared them with the racial make-up of residents in those homes. The summary finding from the project which is making headlines is that long-term care facilities with a higher percentage of black residents provide lower quality care.

First published this summer is a publication known as Health Services Research, the investigation involved analysis of data related to quality of care as well as financial performance over a five year period (1999-2004). Most information was culled from reports provided by the Medicare and Medicaid programs. Those facilities with zero residents on those programs were not included in the research.

The Connection Between Revenue and Nursing Home Care
Importantly, the researchers did not find a link between an individual resident’s race and the quality of care received. Instead they found a link between entire facilities with larger minority populations and the quality of care provided to all residents at that facility, regardless of race. In other words, the problem is not individual discrimination but facility-wide inadequacies.

As discussed in a National Institute of Health article on the research, the root of the problem is mostly financial. Researchers found that homes with larger populations of black residents had lower profit margins and lower overall revenues. Those tighter budgets likely translate into poorer care.

The source of payment is the most probable reason for the variance in facility revenues. Homes that rely more prominently on patients enrolled in the Medicare and Medicaid programs receive lower reimbursements than those with more residents whose care is paid for privately, often via individual long-term care insurance.

On the whole, black residents are more likely than their white counterparts to participate in the Medicaid program. As a result, there is a connection between homes with more black residents, lower revenues, and ultimately, substandard care.

Many different lessons can be taken away from the research. On a system-wide level, closer investigation is needed to determine if Medicaid reimbursement rates are truly too low, or if owners and operators are improperly balancing resident care in order to stretch their own profit margins. Individually, the analysis is a reminder that it is almost always superior to have a plan in place to privately play for long-term care, if possible, instead of relying on the Medicaid system. This is most commonly done by securing long-term care insurance which provides much more flexibility in caregiving options should the need arise.