Nurse Staffing Hours At Nursing Homes With High Concentrations Of Minority Residents, 2001–11

Abstract

Recent increases in state Medicaid payments to nursing homes have the potential to reduce disparities in nurse staffing between facilities with high and low concentrations of racial/ethnic minority residents. Analyses of nursing home and state policy survey data for the period 2001–11 suggest that registered nurse and licensed practical nurse staffing levels increased slightly during this period, regardless of racial/ethnic minority resident concentration. Adjusted disparities in registered nurse hours per resident day between nursing homes with high and low concentrations of racial/ethnic minority residents persisted, although they were reduced. Certified nursing assistant hours per patient day increased in nursing homes with low concentrations of racial/ethnic minorities but decreased in homes with high concentrations, creating a new disparity. Overall, increases in state Medicaid payment rates to nursing homes were associated with improvements in staffing and reduced staffing disparities across facilities, but the adoption of case-mix payments had the opposite effect. Further reforms in health care delivery and payment are needed to address persistent disparities in care between nursing homes serving higher proportions of minority residents and those serving lower proportions, and to prevent unintended exacerbations of such disparities.

Racial and Ethnic Differences in the Prevalence of Depressive Symptoms Among U.S. Nursing Home Residents

“…As a result, many nursing homes lack the necessary resources, expertise, and financial incentives to serve residents with behavioral health issues appropriately (Li, 2010; Muramatsu & Goebert, 2011; Reichman et al, 1998). This issue is particularly salient for nursing homes predominated by racial and ethnic minorities, which are oftentimes low-resource and poor-staffed facilities (Fennell et al, 2010; Li, Harrington, Mukamel, et al, 2015; Li, Harrington, Temkin-Greener, et al, 2015; Mor et al, 2004). It is therefore critical that efforts be made to improve both the overall quality of behavioral health care in nursing homes, and the culture sensitivity of such care given the increased diversity of ethnicities and cultural backgrounds of their residents.…”

“…Our analyses thus further accounted for common nursing home characteristics that may be associated with staff care practices and performance such as ownership, census of Medicaid-financed residents or racial/ethnic minority residents, and nurse staffing levels (see Table 1 for a full list of nursing home variables). Previous studies have shown that for-profit ownership of the nursing home, for example, tends to predict lower quality of depression care (Gaboda et al, 2011; Siegel et al, 2012) and predominance of a facility by Medicaid or minority residents is associated with lower nurse staffing level, more deficiencies in care, and lower financial resources for staff training or performance improvement (Fennell et al, 2010; Li, Harrington, Mukamel, et al, 2015; Li, Harrington, Temkin-Greener, et al, 2015; Mor et al, 2004).…”

“…Despite these extensive reports on older populations of the larger community, little is known about racial and ethnic differences in depressive symptoms among nursing home residents. Racial and ethnic minorities constitute about 20% of the nursing home population, and tend to live in facilities with poorer resources, lower nurse staffing levels, and more care deficiencies than white nursing home residents (Fennell, Feng, Clark, & Mor, 2010; Li, Harrington, Mukamel, et al, 2015; Li, Harrington, Temkin-Greener, et al, 2015; Mor, Zinn, Angelelli, Teno, & Miller, 2004). Analyses of a handful of previous studies (Brown, Lapane, & Luisi, 2002; Gaboda et al, 2011; Jones, Marcantonio, & Rabinowitz, 2003; Levin et al, 2007; Siegel et al, 2012) suggested that racial and ethnic minority residents were less likely to have a physician-confirmed diagnosis of depression than non-Hispanic white residents.…”

Racial and Ethnic Disparities in COVID‐19 Infections and Deaths Across U.S. Nursing Homes

“…Our preliminary analyses suggested nonlinear associations of facility-level racial/ethnic composition with focused outcomes. Thus, similar to previous studies, [14][15][16] we categorized nursing homes into quartiles to capture such nonlinear associations: nursing homes with low proportions of racial/ethnic minority residents (<2.92%, the 25th percentile), medium proportions (2.92%-11.11%, the median), medium-high proportions (11.11%-30.18%), and high proportions (≥30.18%, the 75th percentile). From the NHC files, we obtained a set of nursing home covariates that were found important to COVID-19 infections or deaths, [16][17][18][19] including number of beds, average daily resident census, ownership status (for profit, nonprofit, or government owned), chain affiliation (yes/no), whether the nursing home is affiliated with a hospital, percentage of Medicare residents, percentage of Medicaid residents, average staffing levels (hours per resident day) for RN and for all nursing staff (including RNs, LPNs/LVNs, and certified nursing assistants) in 2019, and five-star ratings for overall quality of care.…”

U.S. Nursing Home Violations of International and Domestic Human Rights Standards

“…47 These disparities have continued over time in nursing homes with high concentrations of minority residents. 48,49 Disparities also occur for nursing home residents paid for by both Medicare (for aged and disabled) and Medicaid (for low-income individuals). These dualeligible residents are more likely to be discharged from hospitals to poorer quality nursing homes with a higher share of Medicaid patients and fewer nurses compared to individuals paid by Medicare only.…”