TY - JOUR
T1 - Environmental and structural factors driving poor quality of care
T2 - An examination of nursing homes serving Black residents
AU - Travers, Jasmine L.
AU - Castle, Nicholas
AU - Weaver, Susan H.
AU - Perera, Uduwanage G.
AU - Wu, Bei
AU - Dick, Andrew W.
AU - Stone, Patricia W.
N1 - Publisher Copyright:
© 2023 The American Geriatrics Society.
PY - 2023/10
Y1 - 2023/10
N2 - Background: Poor quality of care in nursing homes (NHs) with high proportions of Black residents has been a problem in the US and even more pronounced during the COVID-19 pandemic. Federal and state agencies are devoting attention to identifying the best means of improving care in the neediest facilities. It is important to understand environmental and structural characteristics that may have led to poor healthcare outcomes in NHs serving high proportions of Black residents pre-pandemic. Methods: We conducted a cross-sectional observational study using multiple 2019 national datasets. Our exposure was the proportion of Black residents in a NH (i.e., none, <5%, 5%–19.9%, 20–49.9%, ≥50%). Healthcare outcomes examined were hospitalizations and emergency department (ED) visits, both observed and risk-adjusted. Structural factors included staffing, ownership status, bed count (0–49, 50–149, or ≥150), chain organization membership, occupancy, and percent Medicaid as a payment source. Environmental factors included region and urbanicity. Descriptive and multivariable linear regression models were estimated. Results: In the 14,121 NHs, compared to NHs with no Black residents, NHs with ≥50% Black residents tended to be urban, for-profit, located in the South, have more Medicaid-funded residents, and have lower ratios of registered-nurse (RN) and aide hours per resident per day (HPRD) and greater ratios of licensed practical nurse HPRD. In general, as the proportion of Black residents in a NH increased, hospitalizations and ED visits also increased. Discussion/Implications: As lower use of RNs has been associated with increased ED visits and hospitalizations in NHs generally, it is likely low RN use largely drove the differences in hospitalizations and ED visits in NHs with greater proportions of Black residents. Staffing is an area in which state and federal agencies should take action to improve the quality of care in NHs with larger proportions of Black residents.
AB - Background: Poor quality of care in nursing homes (NHs) with high proportions of Black residents has been a problem in the US and even more pronounced during the COVID-19 pandemic. Federal and state agencies are devoting attention to identifying the best means of improving care in the neediest facilities. It is important to understand environmental and structural characteristics that may have led to poor healthcare outcomes in NHs serving high proportions of Black residents pre-pandemic. Methods: We conducted a cross-sectional observational study using multiple 2019 national datasets. Our exposure was the proportion of Black residents in a NH (i.e., none, <5%, 5%–19.9%, 20–49.9%, ≥50%). Healthcare outcomes examined were hospitalizations and emergency department (ED) visits, both observed and risk-adjusted. Structural factors included staffing, ownership status, bed count (0–49, 50–149, or ≥150), chain organization membership, occupancy, and percent Medicaid as a payment source. Environmental factors included region and urbanicity. Descriptive and multivariable linear regression models were estimated. Results: In the 14,121 NHs, compared to NHs with no Black residents, NHs with ≥50% Black residents tended to be urban, for-profit, located in the South, have more Medicaid-funded residents, and have lower ratios of registered-nurse (RN) and aide hours per resident per day (HPRD) and greater ratios of licensed practical nurse HPRD. In general, as the proportion of Black residents in a NH increased, hospitalizations and ED visits also increased. Discussion/Implications: As lower use of RNs has been associated with increased ED visits and hospitalizations in NHs generally, it is likely low RN use largely drove the differences in hospitalizations and ED visits in NHs with greater proportions of Black residents. Staffing is an area in which state and federal agencies should take action to improve the quality of care in NHs with larger proportions of Black residents.
KW - black concentration
KW - long-term care
KW - racial and ethnic disparities
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U2 - 10.1111/jgs.18459
DO - 10.1111/jgs.18459
M3 - Article
C2 - 37306117
AN - SCOPUS:85163133863
SN - 0002-8614
VL - 71
SP - 3040
EP - 3048
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 10
ER -