Hispanic senior citizens are living in nursing homes in ever-increasing numbers, but they face a gap in their quality of care compared to white residents, according to new research from Brown University.
A team led by Mary Fennell, professor of sociology and community health, found that Hispanic elderly are more likely than whites to live in nursing homes of poor quality. These residences are often faced with structural problems, staffing issues and financial trouble.
Details will be featured in the January 2010 edition of Health Affairs. The research follows up and expands upon a landmark 2007 study, also published in Health Affairs, suggesting that blacks are more likely than whites to live in poor-quality nursing homes. Vincent Mor, chair of the Department of Community Health, was a lead author in that study and is a co-author in the new work looking at nursing home care for Hispanics. Temple University was also a partner in the previous research.
Fennell said the paper is the first full-scale analysis of its kind to attempt to look broadly at Hispanics in nursing homes -- what kind of nursing homes they live in and how care at those facilities compares to nursing homes which care mostly for white elderly people. She said the data revealed a sharp disparity in care.
"The most shocking finding is the pervasiveness of disparities in nursing home care that are primarily white, compared to nursing homes that are a mix of whites and Hispanic residences," Fennell said.
Fennell said the findings, in part, reflect a departure from prior patterns of elder care among Hispanic families in the United States. Traditionally, the group has used formal long-term care services less frequently than any other U.S. ethnic group. They had also been less likely than white or black residents to live in nursing homes. In Hispanic households, elder care has traditionally been handled by adult daughters at home, but acculturation and financial issues have forced a growing number of young Hispanic women into work outside the home.
As a result, Fennell said, the loss of home caregivers is occurring even as the growth of the elderly Hispanic population rises dramatically. The authors estimate that more than 5 percent of the current Hispanic population is elderly, a number that is expected to quadruple during the next 10 years. That number should rise to 4.5 million by 2010, according to Fennell and her team.
Fennell and her colleagues found that the overall use of nursing homes has declined since 1985, but the racial/ethnic mix of the national population of nursing home residents has shifted. From 2000 to 2005 -- the period of data used in the study -- the percent of Hispanic residents increased from 5 percent to 6.4 percent, but the percentage of non-Hispanic white residents dipped from just under 83 percent to 79.4 percent.
Nursing home residents are coming increasingly from the lower end of the socio-economic scale, Fennell said, lacking resources for better quality care in assisted living facilities or elsewhere.
Fennell argues that the impact of substandard nursing home care is a complex issue. Residents admitted to nursing homes have often already endured hospitalizations or a health issue that required expensive, high-level care. Once admitted, the individual is then often caught in a spiral of long-term lower quality of life, multiple episodes of poor health and ongoing chronic conditions without a way out.
"People with resources can get into very good places or alternatives for nursing home care," Fennell said. "Everyone else is left with not-very-good facilities that are not performing well."
Fennell is hoping that both federal and state policy-makers pay attention to the data as they shape health care reform policy.
Fennell and Mor, with Zhanlian Feng, assistant professor (research) of community health and Melissa Clark, associate professor of community health, looked at a number of federal sources for their research, including the federal Minimum Data Set on nursing home care, the Online Survey Certification and Reporting Database (OSCAR), and U.S. Census Bureau data. Their nursing home sample included 5,179 nursing homes in operation across the country from 2000 to 2005. About 80 percent of all Hispanic nursing home residents are counted in the analysis.
Fennell's research is part of the program project funded by the National Institute on Aging, on Shaping Long-Term Care in America, based at the Center for Gerontology and Health Care Research at Brown. The datasets used by Fennell and colleagues can be accessed through the program project's web site, LTCFocUS.org, which was launched in early November.
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