Comparisons Made At Nursing Homes
By Jackie Spinner
Washington Post Staff Writer
Tuesday, January 15, 2008; B01
Black nursing home residents in Maryland and Virginia are more likely than white residents to be sent to hospitals for dehydration, poor nutrition, bedsores and other ailments because of a gap in the quality of in-house medical care, according to a study to be published in a medical journal.
Researchers affiliated with Brown University's medical school found that 23 percent of black nursing home residents in Maryland were hospitalized in 2000, compared with 17 percent of white residents. That year in Virginia, the researchers found, 20 percent of black nursing home residents were hospitalized, compared with 18 percent of white residents.
Researchers said the findings in the two states reflected a national trend. Nationally, researchers said, the hospitalization rates were 24 percent in 2000 for black nursing home residents and 19 percent for white residents.
The study is scheduled to be published in the June issue of the journal Health Services Research; findings were released online in November. The study concluded that economic factors were significant in the quality of nursing home medical care. In homes that relied heavily on Medicaid, had lower employee-to-patient ratios or operated without a nurse practitioner or a medical director, residents were more likely to be hospitalized, said Susan C. Miller, associate professor of community health at Brown's Center for Gerontology and Health Care Research in Providence, R.I.
Miller said the findings indicate that the poorest nursing home residents were most likely to be hospitalized.
The study examined data on more than a half-million residents of almost 9,000 U.S. nursing homes, including those in Maryland and Virginia. D.C. homes were not included. But the D.C. ombudsman for elderly board and care said her office sees disparities in treatment between rich and poor and between whites and blacks.
"African Americans are so far behind in money, they are taken advantage of," ombudsman Lydia Williams said.
But Williams said other factors are significant in the quality of medical care residents receive, including how closely relatives monitor the condition of nursing home residents. "It's not just economics," she said.
David Almquist, regional president of Genesis HealthCare in Towson, Md., which has nursing facilities in Maryland and Northern Virginia, said long-term care has improved dramatically in recent years.
For example, he said, Genesis HealthCare's nursing facilities offer renal dialysis, chemotherapy and respiratory services and employ full-time doctors and nurses to help prevent unnecessary hospital trips.
"To look at the industry, the 1990s and today are two different worlds," said Almquist, a board member of the Health Facilities Association of Maryland, which represents nursing facilities. He said he could not address the results of the Brown study.
About a dozen nursing home administrators from the Washington area did not return repeated telephone calls and e-mail requests seeking comment.
The Brown study focused on Medicaid policies, the racial composition of nursing homes and the risk of hospitalization for white and black residents. It concluded that disparities could be eliminated by providing more resources to Medicaid-reliant nursing homes.
"The percentage of residents who had to be hospitalized was strongly correlated with the residents on Medicaid, which also was strongly tied to facilities with limited resources," said Andrea Gruneir, the study's lead author.
Laura Nichols, director of the Northern Virginia Long-Term Care Ombudsman Program, said she was not aware of any complaints to her office about hospitalization rates.
Consumer advocates said that the system favors people who can afford to pay for private nursing home care.
"Nursing homes in this country have a serious deficiency in quality, and studies have shown African Americans are more likely to get the worst care," said Janet Wells, director of public policy for the District-based National Citizens' Coalition for Nursing Home Reform. "We think it's a civil rights issue."
However, Wells and other consumer advocates said a high rate of Medicaid recipients doesn't always determine the quality of care.
"A lot of nursing homes with Medicaid residents are good nursing homes," Wells said. "We see them all over the country."
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