Pave the way for all races in the new LTC landscape

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James M. Berklan, McKnight's Editor
James M. Berklan, McKnight's Editor
“Eye-opening” is the only way to describe results of a new study by Brown University researchers into eldercare usage patterns. In brief, they found that minority residents have been entering nursing homes at a higher rate than in previous decades.

At first blush, that sounds good. But as researchers point out, nursing homes nowadays carry the negative moniker of being a “last resort.” They also bear the brunt of more Medicaid-paid care.

Studies have shown weaker forms of reimbursement correlate with poorer care records.

Meanwhile, white residents have been more likely to move out of nursing homes and make use of the more appealing home- and community-based care options.

The snapshot of the nursing home population nationwide from 1999 to 2008 shows that overall it shrank by more than 6%. The white population dropped more than 10%. Minorities, meanwhile, posted healthy gains — blacks (11%), Asians (54%) and Hispanics (55%).

Although researchers said they tried to neutralize geographic and economic differences, an inescapable implication remains: Minorities are not getting the same access to more desirable forms of eldercare. This goes beyond party politics. The last two administrations (one Republican, one Democrat) have promoted home- and community-based initiatives.

It is understandable that more affluent individuals can personally afford more expensive types of senior housing and care — such as independent and assisted living. These types of housing are more likely to be built in more affluent areas. But opportunities should even out when Uncle Sam gets involved, especially with things such as home- and community-based services (HCBS).

To achieve “rebalancing,” as researchers call it, decision-makers have to know the current balance. That's where the value of the Brown study comes so heavily into play.

School children, regardless of background, are guaranteed access to quality public education. And so it should be at the other end of life. Officials cannot simply skip the “have-nots” when it's time to sample new technology or initiatives in school districts.

If a newer system of long-term care is going to include a strong HCBS element, then concentrated effort should be devoted to improving access for minorities, thereby reducing disparities.