Observational analysis reveals severe quality deficits in predominantly Medicaid nursing homes, highlighting systemic racial and economic disparities.
Key Points
To evaluate socioeconomic and racial inequities in nursing home quality and assess how market-based public quality reporting impacts under-resourced facilities.
Analyzed national data on U.S. nonhospital-based nursing homes, categorizing facilities by their proportion of Medicaid-supported residents.
Evaluated facility staffing ratios, occupancy levels, health-related inspection deficiencies, termination risks, and county-level socioeconomic and racial demographics.
Nearly 15% of nonhospital-based facilities serve predominantly Medicaid residents and demonstrate fewer nurses, lower occupancy rates, and higher numbers of health deficiencies.
Predominantly Medicaid facilities are disproportionately located in the poorest counties, serve more African-American residents, and face higher rates of termination from Medicare and Medicaid.
Public reporting of quality metrics threatens to force resource-constrained homes into closure, which disproportionately eliminates care options for nonwhite residents in low-income areas.