Changes over Time in Racial/Ethnic Differences in Quality of Life for Nursing Home Residents: Patterns within and between Facilities

Abstract

<jats:p> Objectives: To investigate trends in racial/ethnic differences in nursing home (NH) residents’ quality of life (QoL) and assess these patterns within and between facilities. Method: Data include resident-reported QoL surveys ( n = 60,093), the Minimum Data Set, and facility-level characteristics ( n = 376 facilities) for Minnesota. Hierarchical linear models were estimated to identify differences in QoL by resident race/ethnicity and facility racial/ethnic minority composition for 2011–2015. Results: White residents in low-proportion racial/ethnic minority facilities reported higher QoL than both minority and white residents in high-proportion minority facilities. While the year-to-year differences were not statistically significant, the point estimates for white–minority disparity widened over time. Discussion: Racial/ethnic differences in QoL are persistent and may be widening over time. The QoL disparity reported by minority residents and all residents in high-proportion minority facilities underscores the importance of examining NH structural characteristics and practices to ultimately achieve the goal of optimal, person-centered care in NHs. </jats:p>

Racial Disparities in Care Interactions and Clinical Outcomes in Black Versus White Nursing Home Residents With Dementia

“…The hypothesized relationships with regard to agitation, quality of life, use of person-centered care approaches, and hospital transfers were all significantly different between Black and White residents, but in the opposite direction of what was hypothesized. Black residents had less agitation, better quality of life, more person-centered care interventions recommended in their care plans, and fewer hospitalizations over a 12-month period than what has been reported in prior studies 3,32–35. In those studies, there was better quality of life and more emergency department visits and hospitalizations in Black residents than in White residents 3,32–35.…”

“…Black residents had less agitation, better quality of life, more person-centered care interventions recommended in their care plans, and fewer hospitalizations over a 12-month period than what has been reported in prior studies. 3,[32][33][34][35] In those studies, there was better quality of life and more emergency department visits and hospitalizations in Black residents than in White residents. 3,[32][33][34][35] Differences in outcomes may reflect facility-related characteristics such as staffing, access to health care providers within the setting, access to acute care, or individual preferences for hospital transfers or not to go out to the hospital.…”

“…3,[32][33][34][35] In those studies, there was better quality of life and more emergency department visits and hospitalizations in Black residents than in White residents. 3,[32][33][34][35] Differences in outcomes may reflect facility-related characteristics such as staffing, access to health care providers within the setting, access to acute care, or individual preferences for hospital transfers or not to go out to the hospital. It is important to recognize racial differences and focus research on determining the reasons for these differences.…”

“…Compared with White residents, Black residents tend to be younger, more likely to have mental illness, and less dependent in activities of daily living. 3 Black residents are more likely to be in facilities that are more reliant on Medicaid funding, have lower staffing levels, and more regulatory deficiencies in care. 4 Black older adults transition to nursing homes for long-term care rather than choosing to transition into assisted living facilities, as assisted living is mainly private pay while much of nursing home care is covered by government reimbursement.…”

Identifying Nursing Homes With Diverse Racial and Ethnic Resident Compositions: The Importance of Group Heterogeneity and Geographic Context

“…Yet, racial/ethnic disparities in the nursing home (NH) setting are particularly acute (Arling et al, 2007; Cassie & Cassie, 2013; Fennell et al, 2000; Mor et al, 2005; Sengupta et al, 2012; Smith et al, 2008; Travers et al, 2020), as NHs are more racially segregated than other health care settings (Konetzka & Werner, 2009). The size and persistence of racial/ethnic disparities in NHs are well described (Gorges et al, 2019; Rivera-Hernandez et al, 2019; Shippee, Ng, Duan et al, 2020), and have only been exacerbated by the COVID-19 pandemic. Studies have pointed to structural racism as one of the causes of these disparities, manifesting itself via multiple observed pathways, including segregation and racial/ethnic composition of NHs (Boyd et al, 2020; Nolen et al, 2020; Shippee et al, 2022).…”