Black Nursing Home Residents Fare Worse

Abstract

NATIONAL HARBOR, MD. — Preliminary findings from a large federally funded database reveal significant disparities between black nursing home residents and those of other races in certain measures of health and the quality of their care. While previous studies have suggested that black residents may be more likely to reside in nursing home facilities with serious deficiencies, lower staffing ratios, and greater financial vulnerability, national analyses related to the residents themselves have been limited. The new findings from the 2004 National Nursing Home Survey were presented in a poster at the annual meeting of the Gerontological Society of America. Statistician Adrienne L. Jones of the National Center for Health Statistics, Hyattsville, Md., and her colleagues analyzed data for 11,940 nursing home residents aged 65 and older residing in 1,174 facilities. In this nationally representative sample, 12% of the sample were black, with the other 88% comprising whites, Asians, Native Hawaiians or other Pacific Islanders, Native Americans or Native Alaskans, and other races. Hispanics could be included in any of these race categories. The data were collected through a computer-assisted personal interview with members of nursing home staffs familiar with individual residents, with medical records accessed as needed. The findings were adjusted for age and sex. Black residents were more likely than were other races to be totally dependent on staff for both eating and toileting, and were more likely to have both bowel and bladder incontinence. Total dependence for eating was reported for 29% of black residents and 24% of other races. For total dependence in toileting, the percentages were 66% and 61%, respectively, for the two racial groups. The presence of any bladder incontinence was reported for 66% of black residents and 60% of other races, while both bladder and bowel incontinence were present in 55% and 43% of the groups, respectively. Despite the higher prevalence of bladder incontinence in black residents, those with the condition were less likely than were residents of other races to have received a toileting plan. Just 20% of blacks received such scheduling, compared with 26% of other residents. Ms. Jones and her associates said that further analysis should explore this disparity, which could be traced to characteristics of the residents, such as sources of payment for their care, or to aspects of the facilities where they live, such as being located in urban areas. End-of-life instructions were much less common among black residents. Only 43% of blacks had any type of advance directive, whereas 73% of residents of other races did. Black residents were also far less likely to have living wills (7% vs. 21%), and “do not resuscitate” orders (35% vs. 63%). “Although having or not having an advance directive may in part reflect differences in resident preference, black residents are dramatically less likely to have advance directives,” the investigators commented. However, they noted, this analysis could not distinguish between short-term residents likely to return to the community and those at the end of life, who are most in need of advance directives. “We hope to address this limitation in future analysis,” Ms. Jones and her associates said. Pressure ulcers were more common among black residents, with 4% having ulcers of stage 3 or 4 vs. 2% of residents of other races having such severe pressure sores. Future research should focus on nurse-staffing ratios and the presence of wound treatment programs that may affect the occurrence and severity of pressure ulcers, said the researchers. In one finding against the trend of the rest of the study, falls were less common among black residents, with 8% of them having fallen within the past 30 days versus 14% of residents of other races. Future analysis should focus on factors that predict falls, including use of restraints, Ms. Jones and her colleagues said. Miriam E. Tucker is a senior writer with Elsevier Global Medical News.