Racial gap found in 'quality of life' at Minn. nursing homes

Minority residents in Minnesota nursing homes report a lower quality of life than white residents, according to a new study that suggests facilities serving minority neighborhoods may have inadequate staff and resources to serve clients' needs.

The researchers also found that members of racial minorities may have different medical needs that go unaddressed by nursing home staff.

"I think it is in the interest of nursing homes, consumers and policymakers to address this disparity that we see on the facility level," said the lead author, Tetyana Shippee, assistant professor at the University of Minnesota's School of Public Health.

Other studies nationally have found racial disparities in the quality of medical care provided by nursing homes, but the U study is believed to be the first to examine nonmedical outcomes among members of racial minorities. Minnesota is one of two states, along with Ohio, that thoroughly measure quality of life components of care such as personal attention, food and staff engagement.

The researchers found that minority residents have different medical needs than white residents and that they tend to be younger and have longer stays. But they said that did not fully explain the quality gap.

"Racial differences in [quality of life] were less likely to be associated with individual characteristics and more likely to reflect overall facility quality," the report states. "This indicates a need to focus on structural facility-level characteristics."

The study, conducted in conjunction with the Minnesota Department of Human Services, used 2010 data provided by about 97 percent of nursing homes in the state, including nearly 11,000 resident interviews, resident clinical data and reports to state regulators.

Only in the area of room environment did no racial disparity emerge.

Researchers said their data were limited by the number of nonwhite residents, who made up just 3.5 percent of the random sample of residents.

Among nonwhite residents, 55 percent were black, 24 percent were American Indian, 11 percent were Hispanic and 10 percent were Asian.

On average, the minority members were 13 years younger than whites and had a higher prevalence of health problems, including mental illness.

"The fact that we see more minorities with these conditions in nursing homes but not with whites makes me think [minorities] might be better off getting care elsewhere," Shippee said.

Historically, nursing home populations have been predominantly white, while elderly minorities relied more on family and social networks for care. Between 1999 and 2008, however, the number of Hispanics and Asians living in nursing homes grew by 54.9 percent and 54.1 percent, respectively, while the number of black residents increased by 10.8 percent. During the same period, the number of white nursing home residents declined 10.2 percent.

More whites are turning to assisted care facilities, housing vouchers and family members, Shippee said.

In the Minnesota study, resources were a key facility-level predictor of resident quality of life, the study found. Nursing homes with the highest proportion of minorities, mostly in the Twin Cities metro area, were located in poor neighborhoods, had less staff and high levels of Medicaid-only funded residents.

The report concludes that Minnesota programs that measure quality improvement or provide state grants to enhance nursing home resources appear to improve quality of life.

"Other states might consider adopting similar programs to reduce disparities between facilities, but such programs should be tailored to the needs of minority populations when setting incentives," the authors wrote.