The Role of Race in Nursing Home Quality

Unlike seniors who receive aid from at-home caregivers, those in nursing homes have virtually zero control over the actual front-line workers on whom they rely. Upon moving into a long-term care facility, residents immediate count on the individuals who were hired for basic tasks–preventing falls, proper grooming, ensuring nutrition, and more. When those caregivers leave, it is the owners and operators who make decisions about hiring new employees. Residents are left out of the process entirely.

Those of us who work on cases of nursing home neglect appreciate that this theme of complete reliance on others is at the center of the nursing home resident predicament. Much like the trust a medical patient places in their surgeon upon being put under anesthesia, nursing home residents (and their families) must rely on caregivers. In fact, the ultimate trust is actually places in the owners and operators of the homes, who make decisions about hiring caregivers, ensuring adequate resources, sufficient safety policies, and more.

Bad Care Trends
One illustration of the way that owners and operators play such a critical role in resident care is the reality that elder neglect follows clear patterns. Mistreatment of seniors is not spread entirely randomly across facilities and geographic areas. There are clear trends, because single decision-makers can impact countless residents.

Sadly, these patterns of poor care mean that certain groups of individuals are far more likely to receive inadequate care. For one thing, research continues to show that black residents are victims of nursing home neglect more than other groups. The latest study on this issue, published earlier this summer in Health Services Research found that those living in facilities with a higher percentage of black residents were more likely to receive poor care.

The Nursing Home Abuse Research
At the outset it is important to point out that the study did not find that black residents at all facilities were more likely to be mistreated. Instead, the real crux of the problem is that facilities with a higher percentage of black residents generally deliver less adequate services, harming all seniors who live in those homes, regardless of race.

A summary of the study published this month at Medline Plus discussed how the root of the connection is likely financial. Profit margins are generally lower at facilities that have residents who pay privately, usually via private long-term care insurance. Conversely, homes with large percentages of residents on Medicaid have lower revenues. Black residents are more likely to participate in Medicaid.

Understanding the situation may not be as simple as following the money, however. One researcher involved with the project explained, “It isn’t only the financial performance [of nursing homes] that affects performance. There has to be something else affecting quality,”

More work needs to be done before that “something else” is identify. But, regardless of the underlying causes, the law on these matters is clear. All long-term care facility residents deserve reasonable care at all times. This is true whether they are on Medicaid, have private insurance, are in a home with predominantly black residents, or any other characteristic. Failure to provide quality care opens the facility up to being held accountable for their conduct.

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