To date, over 200,000 Americans have died from the COVID-19 pandemic. Over 40% of these deaths have occurred among residents of nursing homes, though this group makes up less than 1% of the U.S. population. This reality makes it critical that policymakers do better to address the needs of this population, though it can’t be through a one-size-fits-all approach. Among nursing homes affected by COVID-19, majority-minority nursing homes have been hit the hardest. In order to fully help all nursing home residents through this pandemic, the reasons behind these racial disparities must be addressed.
Recent research has shown that nursing homes with a higher percentage of Black residents have had significantly more cases and deaths than nursing homes that have a higher percentage of white residents. In fact, over 60% of nursing homes with at least a quarter of Black or Latino residents had reported at least one COVID-19 case back in May. This is double the rate of nursing homes where Black or Latino residents make up less than 5% of the resident population.
These disparities in health outcomes for older adults aren’t new. A 2015 study from researchers at the University of Rochester found that Black nursing facility residents who were recently discharged from a hospital into a nursing home were more likely to be rehospitalized compared to white residents, even when controlling for other risk factors. Researchers hypothesized this was due to the fact that Black residents tended to be admitted to nursing homes that had high rehospitalization rates. Before the pandemic, nursing homes with higher percentages of residents of color were also more likely to suffer from quality issues, such as serious deficiencies, lower staffing ratios, and greater financial vulnerability. Based on recent studies, we now have evidence that higher numbers of nursing home COVID-19 cases and deaths are associated with factors such as low RN-to-patient staffing ratios. The CDC has also strongly recommended that nursing homes make sufficient PPE and testing available. Policymakers should step up to ensure that all nursing homes can meet these basic requirements for sufficient staffing levels and proper amounts of testing and PPE.
In order to fully address these disparities in the long-term, however, the question of why Black residents have been segregated into lower-quality nursing homes in the first place must be considered. First, individuals who require nursing home care often want to stay close to home. This means that the nursing homes they enter are often a reflection of their local community. Communities with a high percentage of Black residents are more likely to be low-income and have nursing homes that rely more heavily on Medicaid than other forms of insurance that pay more for services, leaving less money for other necessities such as RN staff. For nursing homes, location matters.
Systemic racist policies and practices, such as redlining and current discriminatory zoning practices, are also significant reasons for why racial disparities exist in certain locations. On average, Black families have an estimated 1/10th of the wealth that white families do ($17,150 vs. $171,000). Further, a recent National Bureau of Economic Research study on intergenerational mobility found that Black children born into poverty are twice as likely as their white counterparts to remain there. This means that current and future Black nursing home residents will be less likely than their white counterparts to live in areas where they can access higher-quality nursing homes.
It is also notable that communities with a larger percentage of people of color tend to have less access to healthy food options (which can lead to obesity) and are more likely to live in areas with poor air quality (which can lead to asthma), increasing the risk of severe COVID-19 cases.
Despite all of these reasons for why racial disparities might exist in nursing homes during a pandemic, there are still questions to be answered. A recent New York Times study found that even when controlling for location, racial disparities in COVID-19 cases still exist. As research specifically on older adults of color is uncommon, it is critical that policymakers and researchers further study this population to better understand how to address these health outcomes. Other stakeholders can also step up to support such research. For example, AARP has partnered with numerous institutions to conduct their own research on the aging population using a racial lens.
Policymakers should take steps to lessen current disparities in COVID-19 cases and deaths by ensuring specific quality measures are met in all nursing homes. But given the reality of how location is interlinked with these disparities, a more holistic approach for addressing racial disparities is also needed. To fully understand the complexities of such inequities, however, more research needs to be done to ensure the possibility of evidence-based policymaking that will protect and empower our nation’s most vulnerable population.
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