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RACIAL DIFFERENCES IN USE OF NURSING HOMES
Pages 72-104

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From page 72...
... use nursing homes at lower rates than do whites. Various explanations have been offered, including differences in family networks and values, differences in geographic proximity to nursing homes, racial differences in survival and in numbers of elderly people, and racial discrimination.
From page 73...
... In addition, there are indications from some states of a large racial difference in meeting the needs for nursing home care of elderly poor persons within the Medicaid population. Because the federal government, particularly through the Medicaid program, is the major source of money for nursing home care, and this federal involvement triggers the applicability of the Civil Rights Act's prohibition of discrimination, the lack of direct evidence about discrimination in nursing homes is rather remarkable.
From page 74...
... According to the 1977 National Nursing Home Survey, more than 86 percent of nursing home residents require assistance in bathing, 69 percent require assistance in dressing, 52 percent require assistance in using the toilet room, 66 percent can walk only with assistance or are chairfast or bedfast, 45 percent have difficulty with bowel or bladder control, and 33 percent require assistance with eating.5 Fewer than 10 percent are dependent in none of the above activities, and almost one-fourth are dependent in all of them. For almost 80 percent of the patients, the primary reason given for residence in nursing homes is care needs stemming from poor physical health; other reasons included mental illness, mental retardation, behavioral problems, and social and economic reasons.
From page 75...
... Three-fourths of nursing homes (containing almost 90 percent of nursing home beds) are certified to receive federal monies through the Medicare or Medicaid programs, and the federal dollar is the most important source of payment for nursing home care.
From page 76...
... 1969 survey of residents of "nursing and personal care" homes showed that 4.5 of the residents were from groups other than "whites."14 The 1973-74 National Nursing Home Survey showed blacks as 4.6 percent of the nursing home population, while "Spanish-American" patients made up 1.1 percent.15 Comparable figures from the 1977 Nursing Home Survey were 6.2 percent blacks and 1.1 percent "Hispanics."16 Among persons aged 65 and over, members of racial/ethnic groups other than "white" made up 9 percent of the U.S. population, but only 5.2 percent of the nursing home population in 1973-74.17 The 1977 survey showed persons from groups other than "whites" to constitute 6.8 percent of nursing home residents aged 65 and over.
From page 77...
... 496. Data are based on national surveys of nursing homes conducted by the National Center for Health Statistics in the years shown.
From page 78...
... To the extent that poor health and the need for assistance in tasks of daily living define a need for nursing home care for noninstitutionalized people, the need appears greater among the black elderly. Among nursing home residents there is little racial difference in various measures of need and dependency.
From page 79...
... . The sources of the data are National Center for Health Statistics, Vital and Health Statistics, Series 10, No.
From page 80...
... 80 0i to c c o a.
From page 81...
... However, the racial differences in disability among nursing home residents are clearly smaller than such differences among the non-institutionalized population, which suggests that a smaller proportion of the disabled elderly black population than of the disabled elderly white population is admitted to nursing homes. To summarize, evidence from national surveys shows that although disability is more common among elderly blacks than among elderly whites, use of nursing homes is substantially higher for whites than for blacks.
From page 82...
... Differing values are not the only familial explanation that has been offered to account for racial/ethnic variations in nursing home use. The National Nursing Home Survey (1977)
From page 83...
... 7. additional information on racial differences in living arrangements (Table 19)
From page 84...
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From page 85...
... . Although the data from the Shanas study show living arrangements to be reflected in the sources of assistance received by the elderly, neither of these studies shows an overall, consistent racial difference in the ability of the elderly to obtain needed help outside of a nursing home.
From page 86...
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From page 87...
... Data on the extent of black residence in unlicensed boarding and personal care homes would also be instructive in evaluating the extent to which the low representation of blacks in nursing homes reflects blocked access. Less information is available on the role of familial factors in affecting nursing home use of ethnic minorities other than blacks.
From page 88...
... The 1977 National Nursing Home Survey found that personal or family income was the primary source of support for 40.5 percent of white nursing home residents but for only 13 percent of black residents. Conversely, Medicaid was the primary source of support for 72.5 percent of black residents and for 46 percent of white residents.
From page 89...
... More important, because the demand for nursing home care exceeds the supply of beds in many, perhaps most, locations and because three-fourths of nursing homes maintain a waiting list, nursing home operators often have the opportunity to choose between a Medicaid patient and a private-pay patient when a vacancy occurs.42 Payment levels under Medicaid are controlled by each state and, because of cost-containment considerations, are generally lower than the rates charged by nursing homes to private-pay patients. The latter may eventually exhaust their resources and become Medicaid patients, but initially they can be expected to pay more than the Medicaid level.
From page 90...
... By comparison, the 1977 National Nursing Home Survey found 38 percent of nursing home patients to be self-pay (including family payment) and 48 percent to be Medicaid patients.
From page 91...
... (This has undergone revision in accord with the more recent government-wide policy to standardize the collection of racial data.) For comparison, state data on the racial composition of the population above age 65 also are presented (more than 80 percent of nursing home residents are above age 65, according to the 1977 National Nursing Home Survey)
From page 92...
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From page 93...
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From page 94...
... First, aggregate data for some states show a pattern that strongly suggests racial inequity in long-term care under Medicaid. For some reason, poor white elderly patients in these states obtain nursing home care at much higher rates than do poor black elderly patients.
From page 95...
... Racial Segregation in Nursing Homes If racial discrimination affects the use of nursing homes by minority groups, it is reasonable to expect this to be manifest not only in low nursing home use among minorities, but also in patterns of segregation. That is, if discrimination by some nursing homes underlies the disproportionately small numbers of elderly blacks in nursing homes, it would presumably also cause those blacks who are in nursing homes to be concentrated in a limited number of such facilities.
From page 96...
... Although there are obvious reasons for concern about racially segregated nursing homes, the matter has received little attention. The National Nursing Home Survey, conducted periodically by the National Center for Health Statistics, has not collected data that would allow measures, such as percentage of white patients, to be calculated for the separate nursing homes in the sample.
From page 97...
... In describing his sampling approach, he refers to the seven "predominantly black nursing homes" in the state and to their white counterparts. He indicates that the few whites in the black nursing homes are the "most isolated of the long-term state mental hospital 'discharges to the community' who seem to have been selected as the first white nursing home patients to 'break the ice' of racial desegregation in the predominantly black nursing homes." No information is provided about the number or characteristics of the black patients in the white nursing homes.
From page 98...
... Alternative explanations of racial patterns of nursing home use -- demographic differences, differences in family values and living arrangements, and geographic and economic factors -- appear to be inadequate to account for all the racial differences in nursing home use. If, as the committee believes, racial discrimination affects nursing home use, it is important to identify ways in which it may operate and to suggest some potentially useful lines of research.
From page 99...
... The range and type of sources from which a nursing home accepts referrals can heavily influence the characteristics of those who seek admission, and admissions criteria (for example, with regard to Medicaid patients) of nursing homes may have the practical effect of limiting the access of minority groups.
From page 100...
... The possibility that widespread patterns of discrimination exist in nursing home admissions has received little attention, either as a topic for research or as an object of civil rights enforcement activities. Such information probably can be developed by making use of data that are already being collected for other purposes.
From page 101...
... REFERENCES 1. National Center for Health Statistics, The National Nursing Home Survey: 1977 Summary for the United States, Vital and Health Statistics, Series 13, No.
From page 102...
... 15. National Center for Health Statistics, Characteristics, Social Contacts, and Activities of Nursing Home Residents for U.S., 1973-1976, Vital and Health Statistics Series 13, No.
From page 103...
... 35. The National Nursing Home Survey: 1977, p.
From page 104...
... 62. Judith Feder and William Scanlon, "The Shortage of Nursing Home Beds," Journal of Health Politics, Policy and Law 4 (Winter 1980)


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