Racial Disparities in Nursing Home Quality of Care: A Multi-level Analysis on 2004 National Nursing Home Survey Data

Background: Racial disparities regarding nursing home (NH) quality of care are a salient policy concern. Little is known about multi-level influences on NH quality of care among racial minorities. Objective: We examine whether there are racial disparities in NH quality at individual and facility level, using several quality of care measures. Methodology: Resident and facility files from the 2004 National Nursing Home Survey are used. We utilize a Multi-Level Model to study the influence of characteristics at both the facility and individual level on NH quality of care among current Black and White residents age 50 and older. Findings: Compared with older White residents (n=11,410), Blacks (n=1,270) had a higher portion who were age 50-64 (19.92%vs.9.68%) and male (34.80%vs.26.42%). Blacks were less likely to utilize private insurance or Medicare, but were more likely to use the Medicaid (51.59%vs.31.85%). Blacks were more frequently admitted from an acute-care hospital and were dependent in most ADLs. Blacks often experienced trunk, limb and chair restraints. They were more likely to be hospitalized (8.74%vs.6.84%), but less likely to be treated with pain management (36.84% vs.44.06%) or medication (42.55%vs.49.31%). The study examines whether these quality of care disparities remain after accounting for variation in the types of NH (e.g., mainly financed through Medicaid) in which Blacks and Whites typically receive NH care. Implications: In light of the OBRA (1987) legislation and subsequent policy initiatives, these findings at both individual and facility levels will have implications for enhancing NH quality of care among older minority individuals.