The Admission of Blacks to High-Deficiency Nursing Homes

Background:Although the presence of racial and ethnic disparities in nursing home care has been established, there is no work to date examining the relationship between race and government-cited nursing home deficiencies. Deficiencies are evaluations of poor quality made by state surveyors under the federal nursing home certification regulations. Objective:The objective of this study was to examine whether blacks and other minority elders are disproportionately admitted to high-deficiency nursing homes. Research Design:This observational study used a merged file containing individual-level data from the Nursing Home Component of the 1996 Medical Expenditures Panel Study (MEPS) and facility-level quality information from the Online Survey, Certification, and Reporting System. Subjects:The subjects were a 1996 nationally representative sample of 2690 nursing home admissions from the MEPS. Measures:The key variables of interest were the race and ethnicity of newly admitted nursing home residents and the facility's count of government-assigned deficiency citations. Results:Controlling for individual, facility, and market characteristics, blacks were disproportionately admitted to nursing homes with a higher number of deficiencies. In a model that controlled for resident and home characteristics, blacks were admitted to nursing homes that exceeded the mean state deficiency level by 1.32. Conclusions:Policymakers might wish to consider initiatives that provide better quality information to black nursing home consumers, and, to the extent that black consumers lack choice, provide greater resources and better oversight of facilities that care for predominantly black residents.