African-American seniors are four times more likely than their white counterparts to reside in understaffed and poorly funded nursing homes, according to a study published in the Milbank Quarterly.

Brown and Temple university researchers looked at records from more than 14,000 nursing homes in 2000 and identified a two-tiered system of nursing home care. Facilities that had 85% or more of their residents covered by Medicaid, had a low staff retention rate, had fewer financial resources and often restrained patients were labeled  “lower-tier.”

About 15% of nursing homes qualify in the lower tier, according to the study. While 40% of African-American nursing home residents reside in lower-tiered homes, merely 9% of white nursing home residents do.

Vincent Mor, the study’s lead author, said the disparity in nursing-home services results from economic conditions and geographic segregation, with some of the worst homes in Louisiana, Mississippi and Georgia.

The study, funded by the Robert Wood Johnson Foundation, also indicates that Nursing Home Compare Web site, created by CMS, is failing, according to the Washington Post. CMS created the site to increase the overall standard for services. However the study says many nursing homes with low scores do not have enough money to compete with the better homes, and therefore they cannot increase their level of care enough to reach higher scores and may either close or continue to offer substandard care.

The study offered several recommendations to remedy the problem, including increasing Medicaid payments to lower-tier facilities; offering training programs for nursing home managers; giving state and city governments the authority to take over failing nursing homes; and creating a risk pool to relocate lower-tier home residents to other facilities if necessary.