Separate and unequal: racial segregation and disparities in quality across U.S. nursing homes

Health Aff (Millwood). 2007 Sep-Oct;26(5):1448-58. doi: 10.1377/hlthaff.26.5.1448.


We describe the racial segregation in U.S. nursing homes and its relationship to racial disparities in the quality of care. Nursing homes remain relatively segregated, roughly mirroring the residential segregation within metropolitan areas. As a result, blacks are much more likely than whites to be located in nursing homes that have serious deficiencies, lower staffing ratios, and greater financial vulnerability. Changing health care providers' behavior will not be sufficient to eliminate disparities in medical treatment in nursing homes. Persistent segregation among homes poses a substantial barrier to progress.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Black or African American / statistics & numerical data*
  • Centers for Medicare and Medicaid Services, U.S.
  • Certification
  • Civil Rights / legislation & jurisprudence
  • Health Care Surveys*
  • Health Services Accessibility / statistics & numerical data*
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Nursing Homes / standards*
  • Nursing Homes / statistics & numerical data
  • Prejudice*
  • Quality of Health Care / statistics & numerical data*
  • Social Justice
  • Socioeconomic Factors
  • United States
  • White People / statistics & numerical data*