Elderly and ill blacks in the United States are more likely to live in poor-quality nursing homes, researchers said on Tuesday in a study that shows clear patterns of segregation persist.
And in a finding that defies stereotypes, nursing homes in the Midwest were the most segregated, with those in the South the least likely to show disparities, the researchers reported in the journal Health Affairs.
"This study shows us that racial segregation has a significant impact on the quality of care received by nursing home residents," David Barton Smith of Temple University in Philadelphia, who led the study, said in a statement.
Barton Smith's team used U.S. government data on 1.5 million patients in 14,374 nursing homes in 2000, covering close to 90 percent of all nursing homes and residents.
"Blacks were nearly twice as likely as whites to be located in a nursing home that was subsequently terminated from Medicare and Medicaid participation because of poor quality," they wrote in their report.
Disparties in Midwest states
Ten of the 20 nursing homes with the greatest disparities in quality of care were in Wisconsin, Indiana, Ohio, and Michigan. In Milwaukee, blacks are more than twice as likely as whites to live in a nursing home with inspection deficiencies, substantial staffing shortages and financial problems.
The researchers said their report follows up on some well-established research on disparities in U.S. health care, which shows blacks get poorer care regardless of what kind of health insurance they have.
Historically, this has been no surprise, they said.
"Before Medicare and Medicaid were implemented in 1966, nursing homes in the South were totally segregated by Jim Crow laws and in the North almost as much by patterns of use and admission practices," they wrote.
But the federal government scrapped plans to use money Medicare, the state-federal health insurance plan for the elderly, as a way to force desegregation.
"All that nursing homes were required to do to qualify for Medicare was to post signs and certify that they did not discriminate," they wrote.
They suggest that Medicare and Medicaid funding now be used to help close the gap, along with closer monitoring of admissions practices to ensure that they meet Civil Rights Act requirements.
"Our findings imply that it is not sufficient to simply educate nursing homes and other providers to treat everyone fairly and to provide culturally competent care," the researchers concluded.
"We contend that the same basic message holds, in part, for the health system as a whole."