Supports and gaps in federal policy for addressing racial and ethnic disparities among long-term care facility residents

Mauldin, Rebecca L.; Lee, Kathy; Tang, Weizhou; Herrera, Sarah; Williams, Antwan

doi:10.1080/01634372.2020.1758270

Cited by 10 publications

(18 citation statements)

References 31 publications

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“…While unmeasured, per se, as noted earlier, these results reveal potential racial concerns or uneven implementation of personnel policies (Mack et al 2020). They may imply differential treatment or outright discrimination, even overt racism, as reported by Maudlin (2020). Regardless, differential scores suggest more attention to diversity to attain a desirable workplace.…”

Section: Racial-ethnic Identitymentioning

confidence: 51%

“…Mack et al (2020), for example, reported U.S. nursing homes were subjected to continuing institutional racial segregation. Corroborating results on racial disparities were reported by Maudlin (2020) among long-term care residents, representing elder adults and racial-ethnic minorities. Noted in this latter study, however, was the lack of systematic and uniform measure, making it difficult to garner a clear picture of these significant racial issues.…”

Section: Introductionmentioning

confidence: 67%

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Employee Perceptions on Ethics, Racial-Ethnic and Work Disparities in Long-Term Care: Implications for Ethics Committees

McDaniel

Veledar

2021

HEC Forum

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This study explored the perceptions of ethics among long-term care employees (N275) in order to test two hypotheses. A cohort cross-sectional survey examined employees' perceptions of an ethics environment, racial-ethnic, and position disparities (HO1; ANOVA), and, secondarily, ethics in relationship to select, researchgrounded work features measured as manage disagreements, effectiveness, work satisfaction, and opinions of care, the latter including intention to remain (HO2; Pearson Correlations). Established questionnaires with robust psychometrics were employed. Response rate was 51%. Non-significant differences between sample and population on key variables supported extrapolation of results. Statistically significant differences between racial-ethnic (p < 0.03; F 2.42) and work positions (p <0.0001; F 6.24) were revealed on ethics (3.16; HO1). Statistically significant relationships (p <0.0001; r = 0.26-0.68; HO2) between ethics and employees' work features also were found, confirming both hypotheses. Perceptions of ethics based on racial-ethnic and position disparities, as well as the robust links with employee work features, offered potential avenues for decreasing disparities at work and improving the quality of long-term care. Noted further on ethics item scoring were relatively low scores indicating less involvement in, and access to, ethics discussions and decisions. In contrast, the literature review substantiated the importance of empowerment and retention, which were enhanced by employee involvement in work, notably, discussions and decisions. Thus, implications of ethics committees in long-term care sites as ways to potentially enhance employees' work and quality of care, especially work satisfaction and retention, were explored; relevant concerns raised by the Covid pandemic were, briefly, discussed.

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Section: Racial-ethnic Identitymentioning

confidence: 51%

Section: Introductionmentioning

confidence: 67%

Employee Perceptions on Ethics, Racial-Ethnic and Work Disparities in Long-Term Care: Implications for Ethics Committees

McDaniel

Veledar

2021

HEC Forum

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“…Policy decisions restricting Medicaid reimbursement rates are not color blind; low rates of Medicaid reimbursement are correlated with higher levels of racism within a state [23]. Another example of structural factors associated with inequities in health services engagement and health outcomes for LTCF residents is federal regulations that fail to specify racial equity in their oversight of residents' quality of care and quality of life [53], in essence whitewashing the unique experiences and challenges of residents of color.…”

Section: Direct Effects Of Structural Racismmentioning

confidence: 99%

“…Many of the Centers for Medicare & Medicaid Services regulations specifically for LTCF operations pertain to the quality of care and quality of life of residents [53]. Overall, these regulations do not mention race and ethnicity (apart from including "insults based on race" in the definition of abuse).…”

Section: Centers For Medicare and Medicaid Services Regulationsmentioning

confidence: 99%

“…Overall, these regulations do not mention race and ethnicity (apart from including "insults based on race" in the definition of abuse). Rather, they speak more broadly to concerns such as residents' rights to "a dignified existence" and freedom from discrimination in exercising rights [53]. In fact, in crafting the 2014 regulations for Medicaid waivers for Home and Community-Based Services, the Centers for Medicare & Medicaid Services noted they had received several public comments recommending specific non-discrimination protections in the policy but chose not to include them because more general provisions existed elsewhere in Medicaid policy [71].…”

Section: Centers For Medicare and Medicaid Services Regulationsmentioning

confidence: 99%

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Addressing Systemic Factors Related to Racial and Ethnic Disparities among Older Adults in Long-Term Care Facilities

Mauldin¹,

Sledge²,

Kinney³

et al. 2022

Effective Elimination of Structural Racism

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Disparities in older adults’ care and experiences in long-term care facilities (LTCFs) such as nursing homes and assisted living/residential care communities reflect disparities in the broader society. Various policies and institutional practices related to economic opportunity, education, housing, health care, and retirement financing have created and maintain inequitable social structures in the United States. This chapter describes racial and ethnic disparities among older adults in LTCFs in the United States and the systemic factors associated with those disparities. It presents a conceptual framework for understanding the role of structural racism in the racial and ethnic inequities experienced by LTCF residents. In the framework, structural racism directly contributes to racial and ethnic inequities among LTCF residents through LTCF-related policies and practices. Structural racism also indirectly causes disparities among LTCF residents through health and economic disparities. The chapter describes current efforts that address the effects of structural racism within LTCFs and concludes with practice and policy recommendations to redress racial and ethnic disparities among LTCF residents.

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Intersectionality of Race, Ethnicity, and Culture in Neglect, Abuse, and Violence Against Older Persons: Human Rights, Global Health, and Systems Approaches in Pandemics

Morrissey

Brownell

Caprio

2020

Handbook of Interpersonal Violence and Abuse Across the Lifespan

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Supports and gaps in federal policy for addressing racial and ethnic disparities among long-term care facility residents

Cited by 10 publications

References 31 publications

Employee Perceptions on Ethics, Racial-Ethnic and Work Disparities in Long-Term Care: Implications for Ethics Committees

Employee Perceptions on Ethics, Racial-Ethnic and Work Disparities in Long-Term Care: Implications for Ethics Committees

Addressing Systemic Factors Related to Racial and Ethnic Disparities among Older Adults in Long-Term Care Facilities

Intersectionality of Race, Ethnicity, and Culture in Neglect, Abuse, and Violence Against Older Persons: Human Rights, Global Health, and Systems Approaches in Pandemics

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