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Patients With Health Disparities Often Enter Nursing Homes With Chronic Conditions

national health disparity month

April Is National Health Disparities Month

The National Institutes of Health (NIH) estimates nearly two-thirds of individuals who rely on federal and state funding to support their healthcare and long-term care services have multiple chronic conditions. Most of these conditions impact specific racial and ethnic minority communities who have disproportionately been supported with the appropriate diagnosis and treatment needed to thrive. As April marks an opportunity to call attention to these issues under National Health Disparities Month, it’s an important time to start discussion about the significant problems we have in the United States and right here in Illinois, in relation to at-risk populations who receive Medicare or Medical Assistance to treat chronic diseases. These groups are currently battling greater morbidity, mortality, and disability rates as a result of their long-term care coverage.

According to Centers for Medicare & Medicaid Services (CMS), Medicare and Medical Assistance (Illinois’ name for Medicaid) populations that experience disproportionately high burdens of disease are provided worse quality of care, and barriers to accessing long-term care than others. CMS officials say, “these populations include racial and ethnic minorities, sexual and gender minorities, persons with disabilities, as well as individuals living in rural areas.”

A Review of Chronic Conditions Minority Groups Face

The National Institutes of Health supports the claim that the long-term care population differs from other elderly in being comprised of the oldest patients with greater functional limitations and higher disease burden, especially those who have faced health disparities their entire life. These groups of people are more likely to enter a nursing home with chronic diseases such as:

  • Anemia
  • Arthritis
  • Atherosclerosis
  • Congestive heart failure
  • Chronic kidney disease
  • Chronic obstructive pulmonary disease
  • Cerebrovascular disease
  • Dementia
  • Depression
  • Diabetes mellitus
  • Gastroesophageal reflux and acid peptic disorders
  • Hypertension
  • Osteoporosis
  • Thyroid disease
  • Vascular diseases (atherosclerosis, cerebrovascular disease, coronary artery disease, peripheral artery disease)

Because of these conditions and disparities related to income, most will become dependent on Medicaid funded nursing homes to provide their round-the-clock care.

Impact of Supporting Nursing Home Patients with Chronic Diseases

The issues that arise from health disparities in nursing home settings include many. Since most of these populations have not had the proper management of their diseases, they end up in emergency rooms or hospitals to treat their chronic conditions, sometimes unnecessarily. After discharge, their Medicare coverage (if they have it) will not pay if they require a long-term care stay in a nursing home, it will only cover doctor services and medical supplies. The patient must then first wait to be screened via Illinois’ strict rules for Medical Assistance (Medicaid) eligibility and finally, await approval. Once approved, the state’s Medical Assistance program will only pay for a nursing home when it is medically necessary. It will not pay for nursing home care that is just “custodial,” meaning non-medical care such as help with transferring to and from a wheelchair, bathing, or eating. Many individuals with chronic conditions require custodial care.

Meanwhile, these care stays put an even bigger burden on the patient at a time when involuntary transfer rates are at an all-time high likely due to pending care-related charges. Even though care facilities must keep a resident on-site, this isn’t always the case and patients have been left on doorsteps or transferred to facilities that cannot tend to the exact needs required to treat their chronic conditions. Administrators won’t admit this and will find other reasons for eviction, but it is most likely because a payment to their liking has not been received. The person will soon again be treated in an emergency room or hospital setting and their dangerous care cycle continues, jeopardizing their health even further.

Private health insurance policies typically do not cover long-term care, and Medicare coverage for these services is generally limited.

Mapping Minority Health Disparities

The CMS Office of Minority Health has, “designed an interactive map, the Mapping Medicare Disparities Tool, to identify areas of disparities between subgroups of Medicare beneficiaries (e.g., racial and ethnic groups) in health outcomes, utilization, and spending.” The information CMS has gathered should be used to inform policy decisions and to target populations and geographies for potential awareness and screening of chronic disease interventions. The interactive map can provide doctors and clinicians, community health agencies, policy makers, and insurance companies with help identifying areas with large numbers of vulnerable populations and begin to address health disparities related to those who may require a nursing home or long-term care stay. The map contains an enormous amount of information to show exactly what groups are at risk and gives, “health outcome measures for disease prevalence, costs, hospitalization for 55 specific chronic conditions, emergency department utilization, readmissions rates, mortality, preventable hospitalizations, and preventive services.”

Future Outcomes for Minorities Who Require Nursing Home Care

Minority populations identified by CMS for battling health disparities, are too often forced into a nursing home situation because of their chronic disease. Many of these facilities also face struggles with providing a sufficient amount of trained staff and funding, or are not equipped to handle or manage the needs of patients with chronic conditions.

In a July 2017 report prepared by the Illinois Department of Public Health titled Long-term Care Report to the Illinois General Assembly, only vague prevention and planning measures were identified to increase the awareness of health disparities among CMS beneficiaries. We agree with CMS officials that our state needs more dedication to increasing understanding and awareness of health disparities and needs of underserved populations. Change may require Congressional action.

Long-term Care Attorneys Who Support All Populations

If you’re unsure how a health disparity may be impacting your care or the care of a loved one, let us help. For over 25 years we’ve passionately pursued justice for those who have been victims of medical malpractice, wrongful death, nursing home abuse and neglect. Our attorneys are committed to fighting for the best results for you and your family.

Consultations with our attorneys are both free and confidential. Please call us at (312) 332-2872 or complete our free online consultation request form.