Image of Patricia W. Stone, Ph.D., RN, FAAN
Patricia W. Stone, Ph.D., RN, FAAN

A new study in more than 11,000 nursing homes has shown that facilities with any Black residents have higher rates of COVID-19 infection and death when compared with those with no Black residents.

The results suggest that the disparities are rooted at the county level, said researchers from the Columbia University School of Nursing. 

“It is likely that attributes of place, such as resources, services, and providers, important to equitable care and health outcomes, are not readily available to counties where nursing homes have greater proportions of Black residents. Structural bias may underlie these inequities,” said lead author Patricia Stone, Ph.D., director of the school’s Center for Health Policy.

The rates of COVID-19 illness and death were highest in facilities in which at least 50% of residents were Black, Stone and colleagues reported. This finding was more pronounced in rural areas than in urban communities, they found.

Facilities with high rates of adverse COVID-19 outcomes also tended to be for-profit, have staffing shortages, and have at least 75% of residents on Medicaid. What’s more, the provider time per patient decreased as the proportion of Black residents increased.

But when the researchers considered county mortality rates, rurality and other county-level factors, the differences nearly disappeared. This finding suggests that local factors may explain the poor health outcomes, Stone and team concluded.

“It is important that we dismantle the bias and discriminatory structures that continue to fuel these disparities,” she said.

Investment is needed in supportive infrastructure, social services, healthcare, education and housing and neighborhoods, the authors wrote. They also recommend increasing Medicaid reimbursement to directly fund resident care, and making more qualified medical and non-medical staff available — particularly in rural areas.

The researchers used data from the Centers for Disease Control and Prevention and publicly available long-term-care databases reported between mid-January and mid-June 2020.

The study was published in the Journal of the American Medical Directors Association.