Study sees segregation in nursing home care

WASHINGTON - Elderly and ill blacks in the United States are more likely to live in poor-quality nursing homes, researchers said yesterday in a study showing that clear patterns of segregation persist.

And in a finding that defies stereotypes, nursing homes in the Midwest were the most segregated, with those in the South the least likely to show disparities, the researchers reported in the journal Health Affairs.

"This study shows us that racial segregation has a significant impact on the quality of care received by nursing home residents," David Barton Smith of Temple University in Philadelphia, who led the study, said in a statement.

Barton Smith's team used US government data on 1.5 million patients in 14,374 nursing homes in 2000, covering close to 90 percent of all nursing homes and residents.

"Blacks were nearly twice as likely as whites to be located in a nursing home that was subsequently terminated from Medicare and Medicaid participation because of poor quality," the team's report said.

Ten of the 20 nursing homes with the greatest disparities in quality of care were in Wisconsin, Indiana, Ohio, and Michigan. In Milwaukee, blacks were more than twice as likely as whites to live in a nursing home with inspection deficiencies, substantial staffing shortages, and financial problems.

The researchers said their report follows up on some well-established research on disparities in US healthcare showing that blacks are more likely to get poorer care regardless of what kind of health insurance they have.

The researchers suggest that Medicare and Medicaid funding now be used to help close the gap, along with closer monitoring of admissions practices to ensure that nursing facilities meet Civil Rights Act requirements.

"It is not sufficient to simply educate nursing homes and other providers to treat everyone fairly and to provide culturally competent care," the study said.