Objectives To examine the extent to which the racial/ethnic composition of nursing homes (NHs) and their communities affects the likelihood of COVID-19 cases and death in NHs; and whether and how the relationship between NH characteristics and COVID-19 cases and death varies with the racial/ethnic composition of the community in which a NH is located. Design Centers for Medicare and Medicare Services (CMS) Nursing Home COVID-19 data were linked with other NH- or community-level data (e.g. Certification and Survey Provider Enhanced Reporting, Minimum Data Set, Nursing Home Compare, and the American Community Survey). Setting and Participants NHs with more than 30 occupied beds (N=13,123) with weekly reported NH COVID-19 records between the weeks of 06/07/2020 and 08/23/2020. Measurements/ Model Weekly indicators of any new COVID-19 cases and any new deaths (outcome variables) were regressed on the percent of Black/Hispanic residents in a NH, stratified by the percent of Blacks/Hispanics in the community in which the NH was located. A set of linear probability models with NH random-effects and robust standard errors were estimated, accounting for other covariates. Results The racial/ethnic composition of NHs and their communities were both associated with the likelihood of having COVID-19 cases and death in NHs. The racial/ethnic composition of the community played an independent role in the likelihood of COVID-19 cases/death in NHs, even after accounting for the COVID-19 infection rate in the community (i.e. daily cases per 1000 people in the county). Moreover, the racial/ethnic composition of a community modified the relationship between NH characteristics (e.g. staffing) and the likelihoods of COVID-19 cases/death. Conclusions and Implications To curb the COVID-19 outbreaks in NHs and protect vulnerable populations, efforts may be especially needed in communities with a higher concentration of racial/ethnic minorities. Efforts may also be needed to reduce structural racism and address social risk factors to improve quality of care and population health in communities of color.
Objective Explore within and across nursing home (NH) racial disparities in end‐of‐life (EOL) hospitalizations for residents with Alzheimer's disease or related dementia (ADRD), and examine whether severe cognitive impairment influences these relationships. Design Observational study merging, at the individual level, C2014‐2017 national‐level Minimum Data Set (MDS), Medicare Beneficiary Summary Files (MBSF), and Medicare Provider Analysis and Review (MedPAR). Nursing Home Compare (NHC) was also used. Setting Long‐stay residents who died in a NH or a hospital within 8 days of discharge. Participants Analytical sample included 665,033 decedent residents with ADRD in 14,595 facilities. Main outcomes and measures The outcome was hospitalization within 30 days of death. Key independent variables were race, severe cognitive impairment, and NH‐level proportion of black residents. Other covariates included socio‐demographics, dual eligibility, hospice enrollment, and chronic conditions. Facility‐level characteristics were also included (e.g. profit status, staffing hours, etc.). We fit linear probability models with robust standard errors, fixed and random effects. Results Compared to whites, black decedents had a significantly (p < 0.01) higher risk of EOL hospitalizations (7.88%). Among those with severe cognitive impairment, whites showed a lower risk of hospitalizations (6.04%). But EOL hospitalization risk among blacks with severe cognitive impairment was still significantly elevated (β = 0.0494; p < 0.01). A comparison of the base model with the fixed and random‐effects models showed statistically significant hospitalization risk by decedent's race both within and across facilities. Conclusions and relevance We found disparities between black and white residents with ADRD both within and across facilities. The within‐facility disparities may be due to residents' preferences and/or NH practices that contribute to differential treatment. The across facility differences point to the overall quality of care disparities in homes with a higher prevalence of black residents. Persistence of such systemic disparities among the most vulnerable individuals is extremely troubling.
Objective To examine the relationship between Medicaid home‐ and community‐based services (HCBS) generosity and the likelihood of nursing home (NH) admission for dually enrolled older adults with Alzheimer's disease and related dementias (ADRD) and their level of physical and cognitive impairment at NH admission. Data Sources National Medicare data, Medicaid Analytic eXtract, and MDS 3.0 for CY2010‐2013 were linked. Study Design Eligible Medicare–Medicaid dual beneficiaries with ADRD were identified and followed for up to a year. We constructed two measures of HCBS generosity, breadth and intensity, at the county level for older duals with ADRD. Three binary outcomes were defined as follows: any NH placement during the follow‐up year for all individuals in the sample, high (vs. not high) physical impairment, and high (vs. not high) cognitive impairment at the time of NH admission for those who were admitted to an NH. Logistic regressions with state‐fixed effects and county random effects were estimated for these outcomes, respectively, accounting for individual‐ and county‐level covariates. Data Extraction Methods The study sample included 365,310 community‐dwelling older dual beneficiaries with ADRD who were enrolled in fee‐for‐service Medicare and Medicaid between October 1, 2010, and December 31, 2012. Principal Findings Considerable variations of breadth and intensity in county‐level HCBS were observed. We found that a 10‐percentage‐point increase in HCBS breadth was associated with a 1.4 (p < 0.01)‐percentage‐point reduction in the likelihood of NH admission. Among individuals with NH admission, greater HCBS breadth was associated with a higher level of physical impairment, and greater HCBS intensity was associated with a higher level of physical and cognitive impairment at NH admission. Conclusions Among community‐dwelling duals with ADRD, Medicaid HCBS generosity was associated with a lower likelihood of NH admission and greater functional impairment at NH admission.
Objectives: We examined the extent to which home and community-based services (HCBS) spending affected the likelihood of nursing home (NH) placement among black and white HCBS users with Alzheimer’s disease and related dementias (ADRD). Methods: The study population included new HCBS users with ADRD between 2010 and 2013 ( N = 1,046,200). Results: We found that a one hundred dollar increase in monthly HCBS spending was associated with a 0.3 percentage points decrease in the NH placement rate among Whites, but a 0.3 percentage points increase in the NH placement rate among Blacks. The overall NH placement rate was 68.2% and 56.7% for Whites and Blacks, respectively. Discussion: A higher HCBS spending was associated with a decreased likelihood of NH placements for Whites but not for Blacks. It is important to understand how states’ HCBS expansion efforts influence Blacks and Whites with ADRD so that resources can be tailored to communities with different race-mix.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.