Racial/Ethnic Disparities in Nursing Home Quality of Life Deficiencies, 2001 to 2011

Abstract

Objectives Racial/ethnic disparities in nursing homes (NHs) are associated with lower quality of care, and state Medicaid payment policies may influence NH quality. However, no studies analyzing disparities in NH quality of life (QoL) exist. Therefore, this study aims to estimate associations at the NH-level between average number of QoL deficiencies and concentrations of racial/ethnic minority residents, and to identify effects of state Medicaid payment policies on racial/ethnic disparities. Methods Multivariable Poisson regression with NH random effects was used to determine the association between NH minority concentration in 2000–2010 and average number of QoL deficiencies in 2001–2011 at the NH-level, and the effect of state NH payment policies on QoL deficiencies and racial/ethnic disparities in QoL deficiencies across NH minority concentrations. Results Racial/ethnic disparities in QoL between high and low minority concentration NHs decrease over time, but are not eliminated. Case mix payment was associated with an increased disparity between high and low minority concentration NHs in QoL deficiencies. Discussion NH managers and policymakers should consider initiatives targeting minority residents or low-performing NHs with higher minority concentrations for improvement to reduce disparities and address QOL deficiencies.

Health-Related Quality of Life of Economically Disadvantaged African American Older Adults: Age and Gender Differences

“…There is also a particular interest in understanding the factors that can explain decline and those that can be used to enhance HRQoL of aging populations, particularly in demographic and social groups in which HRQoL is low [8,9,10,11,12,13]. Given the consistent disparities across multiple domains of health, African Americans (AAs) report worse HRQoL than Whites [14,15,16,17,18,19]. As a result, it is important to describe the subgroups of AA older adults who report high HRQoL.…”

Addressing Racial Biases in Medicine: A Review of the Literature, Critique, and Recommendations

“…African-Americans receive disparate treatment in the Workers’ Compensation system, 37 the mental health system, 38 the Department of Veterans Affairs health services, 39 and nursing home quality of care. 40 African-Americans receive more undesirable interventions such as amputations; 41 have disparate treatment in HIV care, 42 cardiovascular care, 43 end-of-life, 44 and transplant treatment; 45 are more often misdiagnosed by mental health professionals; 46–49 and fail to receive a broader range of specific medical procedures as compared to whites (see, e.g., Becker and Newsom; 50 Fiscella et al. ; 51 Welch et al.…”

A National-Level Analysis of the Relationship Between Nursing Home Satisfaction and Quality

“…State surveys of deficiencies in NH care are seen as unreliable, potentially reflecting the extent and stringency of enforcement as much as actual differences in quality (Kelly, Liebig, & Edwards, 2008;Levenson, 2014;Miller & Mor, 2008). The NH Compare (NHC) website, which summarizes data from several sources on behalf of consumers, is criticized for the types and reliability of the information included (Government Accountability Office [GAO], 2016;Thomas, 2014). Information about litigation and complaints are hard to access and, again, are criticized for questionable reliability (Konetzka, Grabowski, Perraillon, & Werner, 2015;Studdert, Spittal, Mello, O'Malley, & Stevenson, 2011).…”

“…Evidence shows that people do desire data on consumer satisfaction, regarding both potential short-and long-term NH placements (Gadbois, Tyler, & Mor, 2017;GAO, 2016;Hefele et al, 2016). Moreover, the consumer perspective on quality is particularly salient in NHs, given that the nature of an NH stay extends well beyond receipt of health-care services to touch all aspects of a resident's life (Goffman, 1961).…”

“…Moreover, the consumer perspective on quality is particularly salient in NHs, given that the nature of an NH stay extends well beyond receipt of health-care services to touch all aspects of a resident's life (Goffman, 1961). Indeed, the GAO recently recommended that the federal government consider adding satisfaction data to NHC, based on targeted interviews with key stakeholders at both the national and state levels, as well as internal analyses of satisfaction and other data (GAO, 2016). A handful of states-Maryland, Minnesota, Ohio, and Rhode Island-mandate the collection of consumer satisfaction data.…”