For SNF Quality, It’s All About Location, Location, Location

For nursing home operators, quality depends on multiple factors — including staffing, reimbursement figures and compliance with government regulations. But for potential residents, their neighborhoods may play an outsized role in the type and quality of care they receive.

Skilled nursing facilities in areas with higher concentrations of minority residents and people living in poverty generally provide lower-quality care, according to a new study from researchers at the University at Albany-State University of New York.

Erika Martin and Young Joo Park of UAlbany’s Rockefeller Institute of Government analyzed data from 9,800 nursing homes in 350 metropolitan areas around the country in an attempt to determine the effects of racial makeup, location and poverty on SNF care.


“This study is unique because although existing social epidemiology literature evaluates geographical determinants of population health, it does not focus on institutional outcomes, and the health services and public finance literatures examine determinants of institutional outcomes but have not commonly explored neighborhood effects,” Martin said in a statement announcing the results.

Using a quality scale from 1 to 50, based in part on the Five-Star Quality Rating System from the Centers for Medicare & Medicaid Services (CMS), Martin and Park found that for every 1% increase in the concentration of people living in poverty, nursing home quality dipped 1.20 points. That decline was 0.37 points for every 1% increase in the population of black residents in an area, coupled with a 0.8% lower operating ratio — that is, the relationship between revenues and expenses.

Meanwhile, SNFs that primarily serve minority censuses had an overall lower quality rating, by 2.64 points.


These disparities in care between black and white, affluent and low-income are particularly troubling, the researchers noted, because SNF closures have historically affected those communities: Between 1999 and 2008, for instance, 16% of all U.S. nursing homes closed, but the cuts disproportionately came in neighborhoods with high concentrations of poverty and ethnic and racial minorities.

Martin and Park call on lawmakers to potentially adjust Medicaid policy for facilities located in neighborhoods with high concentrations of minority residents, citing other research that shows structural racism and prejudice still exist in the health care system despite laws preventing outright discrimination.

The study appeared Health Services Research, an academic journal, and was presented at the American Society for Public Administration conference. Park performed the research as part of her PhD. dissertation.

Written by Alex Spanko

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