Nursing facilities with the highest proportion of non-white residents saw COVID-19 infection and death rates that were 3.3 times higher than those with the greatest concentration of white residents, according to a new study that illustrates the disproportionate impact of the novel coronavirus on communities of color — both in long-term care and generally.
The troubling gulf in outcomes between white and non-white nursing home residents is the result of several endemic factors, University of Chicago researchers Rebecca Gorges and R. Tamara Konetzka determined, and not necessarily implicit or explicit biases among nursing home workers at the facility level.
Simply put, even before the pandemic, people living in predominantly Black and brown neighborhoods had generally worse options for post-acute and long-term care than their mostly white counterparts. With the pandemic at large hitting those same areas harder than white neighborhoods, the combination put non-white nursing home residents at profound risk.
“Because minority communities experience the highest rates of COVID-19 infection and nursing homes in those communities are generally of lower quality, non-White nursing home residents are in the eye of that perfect storm,” Gorges and Konetzka concluded.
In particular, the generally larger size of nursing homes in non-white areas, coupled with the overall higher number of cases in the surrounding community, conspired to drive up death and infection rates.
“Focusing limited available resources on facilities with high proportions of non-White residents is needed to support nursing homes during potential future outbreaks,” the researchers recommended.
While the sheer magnitude of the disparity is a new revelation, the trend has been documented since the early days of the pandemic. Back in late May 2020, Konetzka presented data showing that the racial makeup of a facility was a significantly stronger predictor of negative COVID-19 outcomes than its federal quality rating from the Centers for Medicare & Medicaid Services (CMS) or for-profit status.
“Nursing homes are often a reflection of the neighborhoods in which they are located,” Konetzka said during a May hearing held by the Senate Special Committee on Aging. “Consistent with the pandemic generally, nursing homes with traditionally underserved, non-white populations are bearing the worst outcomes.”
In the February 2021 study, the researchers identified four primary differences between facilities in white and non-white neighborhoods:
- Non-white people are more likely to live in larger facilities, which research has proven are more susceptible to viral outbreaks and other infection-control failures
- Non-white people are generally less healthy when first entering a nursing home, putting them at an even greater risk of succumbing to COVID-19 or other acquired infections
- The facilities in non-white neighborhoods are likelier to have for-profit ownership, a heavier reliance on Medicaid as a funding source, and a history of deficiencies
- Community COVID-19 infection rates are generally higher in non-white neighborhood
“Researchers have consistently reported that segregation is present in nursing homes and that nursing homes with higher proportions of non-White residents are associated with worse-quality care,” Gorges and Konetzka wrote. “Our results suggest that the COVID-19 pandemic may have exacerbated this inequity.”
The study, published in the journal JAMA Network Open, comes at a time where lagging rates of COVID-19 vaccine uptake among Black Americans have also been in the headlines.
As with the disparity in nursing home outbreaks, there are several factors behind those gaps, including the socioeconomic — older Black people are less likely to have at-home access to the online portals that many municipalities have relied upon to schedule vaccine appointments, for instance — and the historic, as generations of people mistreated and neglected by the health care system at large struggle to trust a new and hastily developed vaccine.
Moving forward, Gorges and Konetzka called on the leaders in charge of the vaccine rollout to keep these baked-in disparities in mind when working to inoculate as many people as possible.
“The negative consequences of the pandemic for nursing home residents are likely to be ameliorated, although not eliminated, with the emergence of vaccines and the prioritization of vaccine delivery to residents and staff in long-term care facilities,” they concluded. “As vaccination proceeds, it will be important for policymakers to consider existing inequities to ensure that the process of vaccine distribution includes particular efforts to reach communities of color.”