Nursing homes with 50% or more Black residents have higher rates of emergency department visits and hospitalizations than facilities with no Black residents, likely due to lower rates of registered nurse staffing, a new study has found.
Facilities in the United States with relatively more Black residents have experienced ongoing issues with poor quality of care, a problem that was more pronounced during the COVID-19 pandemic, the researchers reported.
In the new study, researchers sought to understand the environmental and structural characteristics that may have led to poor healthcare outcomes in these nursing homes before the pandemic.
To do so, they studied multiple 2019 national datasets for more than 14,000 facilities, examining hospitalizations and ED visits. They also looked at structural factors such as staffing, ownership status, bed count, chain membership, occupancy and percent Medicaid as a payment source. Region and urbanicity were taken into account as well.
Nursing homes with 50% or more Black residents were more likely to be urban, for-profit, located in the South and with more Medicaid-funded residents when compared to nursing homes with no Black residents, the researchers reported. Ratios of RN and aide hours per resident per day were also lower in these facilities, and ratios of licensed practical nurse hours per resident per day were higher.
What’s more, “in general, as the proportion of Black residents in a nursing home increased, hospitalizations and ED visits also increased,” the researchers wrote.
Prior studies have linked lower use of RNs in nursing homes to overall increases in ED visits and hospitalizations. It is therefore likely that low RN staffing is driving these differences in hospitalizations, the investigators theorized.
“Staffing is an area in which state and federal agencies should take action to improve the quality of care in nursing homes with larger proportions of Black residents,” the authors concluded.
Full findings were published in the Journal of the American Geriatrics Society.
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