Diving into disparities
There is little that makes McKnight's readers as defensive as publishing a story about racial disparities in long-term care. The comments often complain that access to care is complicated and shouldn't be simplified to focus on race.
Good news! The Centers for Medicare & Medicaid Services has heard you, kind of, and has created a large-scale plan for improving the quality of care for minority and other underserved Medicare beneficiaries, with a particular interest in nursing homes.
In collaboration with the University of Chicago, CMS' Office of Minority Health released an equity plan designed to “support access to high quality care, promote healthcare system efficiency, and ensure affordable health coverage.”
The reason for the plan: In addition to racial and ethnic minorities, Medicare populations experiencing worse care, barriers to care and high burdens of disease are sexual and gender minorities, people who are disabled and those in rural areas. The plan also tackles beneficiaries with chronic diseases, including diabetes, chronic kidney disease and cardiovascular disease, all of which are problems that can lead to a senior needing long-term care.
Now, the part you've been waiting for: CMS “is increasing the provision of culturally and linguistically appropriate care in nursing homes” as part of the plan.
“Nursing homes serve vulnerable and culturally and linguistically diverse populations including racial and ethnic minorities, sexual and gender minorities, and persons with disabilities,” the report states, which means there needs to be training in cultural competency. This means training related to race, ethnicity, language, disability, sexual orientation, and gender identity for members of the care team.
This is not coming out of nowhere, but studies that have shown how “sexual and gender minority elders experience discriminatory and culturally insensitive treatment in nursing homes and long-term care, causing stress for these individuals and their families.” While CMS is focused on beneficiaries and long-term care residents, I have hope the training will extend to understanding for employees: Witness allegations for firing an employee for being transgender or wearing a hijab, or around lack of accommodation for those with disabilities. Roll your eyes or complain about being “politically correct” all you want, but investing in training and education can go a long way toward diminishing the likelihood of a lawsuit or paying a settlement. Also, no one is ever harmed by a push to become a better human being.
CMS' plan is divided into multiple parts, the first of which is improving understanding on why these disparities exist and why the government needs to address them. The second part is on testing strategies and interventions and sharing tools with stakeholders. The third part is getting support and making adjustments to create success. With nursing homes and disparities, CMS said it will work “to increase the provision of culturally competent care in nursing homes by testing and implementing the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (National CLAS Standards) in nursing homes,” the report states.
Additionally, there's another piece of the puzzle related to reimbursement: Hospital admissions and readmissions and how much they cost Medicare.
“It is not clear if racial and ethnic minorities, sexual and gender minorities, and persons with disabilities are disproportionately represented in readmissions, but there is clear data showing that these groups are disproportionately affected by mental illness and comorbid chronic conditions. Tailored approaches to care coordination can help to reduce disparities among these vulnerable populations,” the report states.
Ultimately, CMS is giving providers a chance to be part of the discussion of making care more accessible for everyone. Embrace it.
Elizabeth Newman is Senior Editor at McKnight's. Follow her @TigerELN.
Elizabeth's Etiquette Tip of the Week: The “Quiet Car” is a wonderful benefit of Amtrak and certain other regional trains, where business travelers can work in peace. However, this means you cannot talk on your cell phone - you must excuse yourself to take a call in another section. If you are playing music, you must wear headphones and keep the volume low. While there are sadly no equivalent on planes, I've been surprised recently to see how many of my plane seatmates were playing music on their phones without headphones, and can only assume they were engaged in performance art involving alienating everyone on the plane.