Health Care Disparities Uncovered in Nursing Homes

Nursing homes, the nexus of the COVID-19 pandemic, might also become the nexus of an examination into health care disparities that the coronavirus uncovered. Nursing homes with Black residents had a greater number of COVID-19 infections and deaths during the pandemic than those without Black residents, a new study from Columbia University School of Nursing found.

The study, published in the Journal of American Medical Directors Association, included data from 11,587 nursing homes in the United States that reported data to the US Centers for Disease Control and Prevention during the pandemic.

“COVID created a crisis in nursing homes, that’s for sure. I think everybody has heard that over the past year, and it’s worse for minorities,” Pat Stone, PhD, director of the Center for Health Policy at Columbia University School of Nursing told Contagion. “It exacerbated health disparities. That’s the biggest takeaway.”

Pat Stone, PhD

Among nursing homes included in the study, 3639 (31.4%) had no Black residents, under 20% of residents were Black in 1020 (8.8%), Black residents accounted for 20% to 49.9% of residents in 1586 (13.7%), 50% or more residents were Black in 681 (5.9%) nursing homes, and race was not reported for 4661 (40.2%) nursing homes.

COVID-19 infections were 13.6 percentage points higher in nursing homes with 50% or more Black residents, and deaths were 3.5 percentage points higher.

Stone attributed the disparities to structural racism, saying that nursing homes that have a high percentage of Black residents have fewer resources, poor staffing, worse infection control processes and a higher dependence on Medicaid with fewer patients on Medicare.

“We need to fight for these vulnerable people that are living in nursing homes and provide the best care,” Stone said. “We need advocacy because we need to have some changes in policies.”

The study found that disparities were greatest in rural settings and that nursing homes with the highest proportion of Black residents were more likely to be for-profit organizations, report staffing shortages, have the highest percentage (about 75%) of residents on Medicaid, have lower RN and aide hours per resident.

Other factors included that nursing homes with a large proportion of Black residents were located in communities with a scarcity of resources such as transportation and health services and with low socioeconomic indicators such as education and income along with mistrust in the healthcare system.

The study authors call for investments in infrastructure, social services, health care, education and housing in Black communities and an increase in Medicaid reimbursement to nursing homes. But even before the reinforcements arrive, nursing home care can be improved for a relatively small investment, as Infection Control Today® (ICT®) reported last July. ICT® also reported on how one long-term care facility managed to hold off COVID-19.

Stone said she will continue to research infection prevention and control measures, such as having a certified infection preventionist on staff in nursing homes, which has been associated with improved resident outcomes. Ann Marie Pettis, RN, BSN, CIC, FAPIC, the president of the Association for Professionals in Infection Control and Epidemiology, told ICT® last June that states should mandate that a fulltime infection preventionist be assigned to every long-term care facility, something that states don’t currently mandate. In addition, the sad fact is that, despite billions more allocated for nursing homes, the facilities are losing employees in droves.

For her part, Stone plans to continue her research on the impact of health disparities on infection prevention and control measures.

“This is really changing the landscape of infection prevention and control, which needed to be done. But we don’t know how that’s going to look a year from now and we don’t know how that will look for nursing homes that serve minorities,” Stone said. “Will they be able to make these changes as well as other nursing homes? So, that’s where my research is going next.”

Racial disparities in COVID-19 infection and mortality rates have been a topic of ongoing research during the pandemic. A recent study found that social and environmental factors have a greater impact on disparities than biological or genetic differences.

A study by British investigators that evaluated COVID-19 health disparities underscored the long history of inequities throughout history and around the globe.

Jonna Lorenz is a freelance journalist with more than 20 years of experience. Her background is in business and health care news, including reporting, editing and research for newspapers and websites.

This article first appeared in Contagion®.