Racial Segregation Across U.S. Nursing Homes: A Systematic Review of Measurement and Outcomes

Gerontologist. 2020 Apr 2;60(3):e218-e231. doi: 10.1093/geront/gnz056.


Background and objectives: Nursing homes remain subjected to institutional racial segregation in the United States. However, a standardized approach to measure segregation in nursing homes does not appear to be established. A systematic review was conducted to identify all formal measurement approaches to evaluate racial segregation among nursing home facilities, and to then identify the association between segregation and quality of care in this context.

Research design and methods: PubMed, Scopus, and Web of Science databases were searched (January 2018) for publications relating to nursing home segregation. Following the PRISMA guidelines, studies were included that formally measured racial segregation of nursing homes residents across facilities with regional-level data.

Results: Eight studies met the inclusion criteria. Formal segregation measures included the Dissimilarity Index, Disparities Quality Index, Modified Thiel's Entropy Index, Gini coefficient, and adapted models. The most common data sources were the Minimum Data Set (MDS; resident-level), the Certification and Survey Provider Enhanced Reporting data (CASPER; facility-level), and the Area Resource File/ U.S. Census Data (regional-level). Most studies showed evidence of racial segregation among U.S. nursing home facilities and documented a negative impact of segregation on racial minorities and facility-level quality outcomes.

Discussion and implications: The measurement of racial segregation among nursing homes is heterogeneous. While there are limitations to each methodology, this review can be used as a reference when trying to determine the best approach to measure racial segregation in future studies. Moreover, racial segregation among nursing homes remains a problem and should be further evaluated.

Keywords: Aged; Healthcare disparities; Long-term care; Quality of care; Race/ethnicity; Residential segregation.

Publication types

  • Research Support, N.I.H., Extramural
  • Systematic Review

MeSH terms

  • Aged
  • Black People / statistics & numerical data
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Nursing Homes / statistics & numerical data*
  • Quality of Health Care / statistics & numerical data*
  • Social Segregation*
  • United States
  • White People / statistics & numerical data