Certain organizational and community factors may influence racial differences in access to and quality of nursing home care. For instance, some nursing homes close to one another in the same community have a very different mix of black and white residents. This suggests that nursing home segregation exists. However, it is difficult to disentangle this segregation from the underlying geographic segregation, according to the Brown University researchers who conducted the study. They studied racial mix in nursing homes and the surrounding communities in four States: Kansas, Mississippi, New York, and Ohio. This research was supported in part by the Agency for Healthcare Research and Quality (HS10322) and led by Mary L. Fennell, Ph.D.
Generally, the proportion of blacks residing in the nursing homes within a county resembled the mix of blacks in the county's population. However, certain exceptions provided evidence of segregation. For instance, in Kansas counties where there were no blacks, 94 percent of nursing homes had no black residents, 4 percent had a 0.1 to 5 percent mix of black residents, and only 2 percent had 5.1 to 10 percent blacks. Yet in Mississippi, there were numerous counties with 20 percent or more blacks who had only one nursing home. That nursing home typically had a black mix of less than 5 percent or 5 to 20 percent of residents. In fact, in counties where the population was 20 percent black, only 58 percent of nursing homes had 20 percent or more black residents; in 11 percent of nursing homes, less than 5 percent of residents were black.
The opposite was true in New York, where blacks represented .1 to 5 percent of the population in 87 percent of the counties. In these counties, 7 percent of nursing homes had a patient mix that was greater than 10 percent black, but 32 percent of homes had no black residents. In Ohio, no county was more than 20 percent black, and 86 percent of counties were less than 5 percent black. Nursing home residents in primarily white counties tended to mirror those demographics. However, in counties where blacks made up 5 to 20 percent of the population, 28 percent of nursing homes had larger proportions of black residents than observed for the county populations.
See "Facility effects on racial differences in nursing home quality of care," by Dr. Fennell, Susan C. Miller, Ph.D., M.B.A., and Vincent Mor, Ph.D., in the July/August 2000 American Journal of Medical Quality 15(4), pp. 174-181.