Nursing homes in predominately minority areas are often of lower quality and are more likely to close, while assisted living facilities are more likely to be built in areas where residents have high incomes. Recently built assisted living facilities are marketed toward middle- and upper-income people. When you overlay economics with age you tend to find the majority of people who can afford these facilities are white. The result being medically able whites abandon nursing homes for assisted living facilities and home care, their beds are then backfilled by Blacks. This results in a disparity that manifests not only economically but also racially.
In fact, the numbers of minority residents in nursing homes increased proportionately more rapidly than the minority population overall, even in areas with high concentrations of minorities. These results may indicate unequal minority access to home care and assisted living alternatives, which are generally preferred for long-term care.
Moreover, despite the steady growth of private pay home care and assisted living facilities, the majority of Medicaid long-term care spending still goes toward nursing home care. Said another way, since a high percentage of minorities rely on Medicaid to pay for care, they are being directed to nursing homes when the elderly population who can afford to pay out-of-pocket for services are choosing alternatives such as assisted living facilities or home care.
Lastly, another potential explanation of the observed racial separation is exclusionary practices. Many long-term care facilities have preserved the ability to control who gets admitted through control of payer mix, case mix, duration of stay and race. This is significant because, in general, African American elderly are less wealthy, in poorer health and have more chronic and disabling conditions compared with white elderly.
What To Do?
As we move forward we may suggest to policy makers, health care providers and payor sources that a “rebalancing” may be needed. For example, Medicaid funding options may need continued expansion from nursing homes to other forms of care and should increasingly include assisted living facilities and home care. As it is, whites are clearly more likely to use these more desirable alternatives.
More emphasis and funding may be required to promote minority elders’ use of them, too, if a more race neutral elder care future is desired. Otherwise, questions about the nature and quality of long-term care received by minority groups will eventually need to be addressed.
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