Nursing Home Closures Are Higher in Minority, Poor Areas
It is estimated that by 2050, nearly 27 million people in the United States will need long-term care—but if they’re a minority or live in an impoverished area, they may not have anywhere to go, according to a study published the Archives of Internal Medicine that found that nursing home closures are concentrated in areas that are less affluent or have a high concentration of Latino and Black residents.
For the study, researchers at Brown University in Providence, Rhode Island, analyzed information from a national database of Medicare/Medicaid-certified nursing homes in the United States from 1999 to 2008. The database contained information from more than 18,000 nursing homes from all 50 states. The researchers used data from the 2000 census to map nursing home closures by state and zip codes and then matched zip codes to data on poverty and racial and ethnic makeup.
Results showed that a total of 2,902 freestanding and hospital-based nursing homes closed between 1999 and 2008. In the freestanding facilities, risk of closure was 37 percent higher in the zip codes with the highest percentage of Latinos and 38 percent higher in the zip codes with the highest percentage of blacks versus those zip codes with the lowest percentage of Latinos and blacks.
In addition, results showed that the risk of closure in zip codes with the highest levels of poverty was more than double the rate of closure in zip codes with the lowest rates of poverty.
“In the broader context of structural and socioeconomic disparities and persistent racial residential segregation, the clustering of nursing home closures in poor and minority- concentrated urban neighborhoods is troubling,” wrote the study authors. “This phenomenon, arguably, resembles similar dynamics of inequalities in public schools, housing, environmental decline and other sectors.”
In an accompanying editorial, the study authors also expressed concerns that as the population ages, whole groups of people will have limited access to quality care. As a result, doctors noted, these disparities could force elders to be placed in facilities far from their communities, which would limit the visitors they’d receive.
But doctors are working on solutions. In an editorial from Mitchell H. Katz, MD, of the San Francisco Department of Health, noted that Medicare should start helping pay for assisted living and alternatives to home care, that doctors should demand that facilities be located in the communities where their patients live, and that doctors should be more present in nursing homes to raise their quality of care.
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