Deficiencies In Care At Nursing Homes And Racial/Ethnic Disparities Across Homes Fell, 2006-11

Abstract

Despite the increased use of nursing homes by minority residents, nursing home care remains highly segregated. Compared to whites, racial/ethnic minorities tend to be cared for in facilities with limited clinical and financial resources, low nurse staffing levels, and a relatively high number of care deficiency citations. We assessed the trends from 2006 to 2011 in those citations and in disparities across facilities with four different concentrations of racial/ethnic minority residents. We found that the number of health care-related deficiencies and the percentage of facilities with serious deficiencies decreased over time for all four facility groups. From 2006 to 2011 the average annual number of health care-related deficiencies declined from 7.4 to 6.8 for facilities with low minority concentrations (<5 percent) and from 10.6 to 9.4 for facilities with high minority concentrations (≥35 percent). In multivariable analyses, across-site disparities in health care-related deficiencies and in life-safety deficiencies narrowed over time. We also found that increasing the Medicaid payment rate might help improve both overall quality and disparities, but state case-mix payment approaches might worsen both. These results suggest the need to reevaluate quality improvement and cost containment efforts to better foster the quality and equity of nursing home care.

Keywords: Disparities; Long-Term Care; Quality Of Care.

EXHIBIT 1

Caption: Trend In The Average Number Of Health Care–Related Deficiencies In Freestanding Nursing Homes By Concentration Of Racial/Ethnic Minority Residents, 2006–11 Source/Notes: SOURCE Authors' analysis of data for 2006–11 from the Online Survey Certification and Reporting (OSCAR) files and the LTCFocus files.

EXHIBIT 3

Caption: Difference In Average Number Of Health Care–Related Deficiencies Between Nursing Homes With High Concentrations Of Racial/Ethnic Minority Residents And Those With Low Concentrations By State Source/Notes: SOURCE Authors' analysis of data for 2010 from the Online Survey Certification and Reporting (OSCAR) file and the LTCFocus file. NOTES States were not included if in 2010 they had fewer than five nursing homes in the group with low (< 5 percent) minority concentrations (HI and NM) or fewer than five nursing homes in the group with high (≥ 35 percent) minority concentrations (AK, IA, ID, ME, MN, MT, ND, NE, NH, NV, OR, RI, SD, UT, VT, WV, and WY). The District of Columbia was also excluded because in 2010 it had fewer than five nursing homes in the high-concentration group.