Do Nursing Homes Treat Blacks and Whites Differently? Evidence from New York State

The occurrence of pressure ulcers (PUs) in nursing homes (NHs) is a marker for poor quality of care. We examine whether racial differences in PU rates among NH residents are due to within or across-facility disparities.

2006-2007 Minimum Data Set records for NHs were linked with the OSCAR database. Long-term care (LTC) residents with high risk for PUs were identified. The dependent variable indicates PU presence/absence on any quarterly assessment. Race is the main independent variable of interest. Other variables include individual and facility characteristics.

The analytical sample includes 61,153 LTC high-risk residents (18% black & 82% white) in 648 NHs. We fit three risk-adjusted models - logit, conditional fixed-effects logit, and a random-effects logit model with bootstrapping SEs.

PU prevalence is 14.49%; 18.03% for Blacks and 13.73% for Whites. Overall, Blacks are 21% more likely to have PUs than Whites, controlling for risk factors (OR=1.21, P<0.001). We find no such effect within facilities, after controlling for facility fixed effect (OR=0.98, P=0.66). These two ORs are significantly different across two models (P<0.001). The random and the fixed effects models shows similar results demonstrating that higher PU presence among Blacks is associated with greater facility-specific concentration of Black residents (P=0.01).

Greater PU occurrence among Blacks is not the result of differential within-facility treatment of Black versus White residents. Rather, Blacks are more likely to reside in facilities with poorer care quality. To improve PU care for Blacks, efforts should focus on improving the overall quality of care for black-centered facilities.