Is there 'white flight' from US nursing homes?
Minority elders are more frequently becoming nursing home residents compared to whites, a new study reveals.
Available nursing home spots in the United States decreased over 6 percent between 1999 and 2008, while still having to accommodate 1.2 million people.
A disproportionate number of residents are black, Latino and Asian, the study finds. And, compared to 1999, fewer residents are white. The study, published in Health Affairs, focuses on the top 10 metropolitan areas for each minority group.
While nursing home admissions fell by 10 percent for white elders, admissions are up 11 percent for blacks, and even more for Hispanics and Asians — over 50 percent.
This increase might suggest better access to nursing home care for minorities, but lead researcher, Dr. Zhanlian Feng, of Brown University, explains that it may be the opposite. The higher rates are actually due to a lack of access to more desirable care options for elders of ethnic minority groups, he says.
“Seemingly, we are closing the gap in terms of minority access to nursing home beds, but I don’t think that is something to celebrate,” Feng says. “They are really the last resort. Most elders would rather stay in their homes, or some place like home, but not a nursing home unless they have to.”
The study suggests that the growth in the number of minority elders living in nursing homes may be driven largely by demographics and disparities.
Nursing homes located in areas with high proportions of ethnic minorities are often of poorer quality and more likely to shut down than those located in high-income areas, previous research has shown.
Assisted living facilities — facilities where elders live independently in private units, but in a supervised setting with staff members available to help and ensure their safety — are more likely in areas of high income.
The result is a disparity that plays out not only economically and geographically, but also racially, Feng says, reflecting on his findings.
“We know those alternatives are not equally available, accessible, or affordable to everybody — certainly not to many minority elders,” says Feng.Researchers found differences within ethnic groups based on location as well. For example, there was an increase in nursing home residence of 22 percent for elder blacks in New York, but only 1 percent in the Los Angeles and Long Beach areas.
The findings could have important implications and highlight challenges for policy makers as they seek to re-balance elder care from nursing homes to other forms of care. Shifts in Medicaid funding to support home and community-based services need to account for these disparities.
In addition to disparities surrounding minority elders entering nursing homes, another recent study reveals poor communication of health issues to black nursing home residents. At the onset of the winter flu season, black care home residents are less likely to receive flu shots than white counterparts.
One study shows that black residents refused vaccines over 12 percent of the time they were offered — 4 percent more frequently than white residents. However, black residents were also less likely to be offered the vaccines.
By 2030, an estimated 20 percent of the US population will be 65 or older, according to the U.S. Census Bureau, with the numbers of ethnic minority seniors growing particularly fast. The shift away from nursing home care and towards home and community-based care, which are reportedly less expensive options, will be welcome by elders, as these care options are overwhelmingly preferred.
However, comprehensive data about the full range of home and community-based care options remains scarce.
Understanding and assessing the services available and to whom they are available will help effectively re-balance elder care. But without creating policy based on this information, the study concludes, inequities for minority elders will grow.
“Ultimately, poor minority elders may be increasingly relegated to nursing homes, while whites with more financial resources are able to use various home and community-based alternatives,” Feng says.