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Proportion of black residents, profit status, and community locale influence the type of care provided at U.S. nursing homes

Studies have indicated that black nursing home residents are less likely than white residents to receive appropriate medication. However, one has to look beyond individual resident race when assessing the quality of nursing homes, suggests a study of 408 urban New York nursing homes. Researchers found that the racial composition and profit status of the nursing home, as well as the racial composition of the community in which it was located, influenced the quality of care for black and white residents. For example, black and white residents of nursing homes with higher proportions of blacks were less likely to be restrained, but were more likely (though not significantly) to receive antipsychotic drugs.

Also, black and white residents of for-profit homes were more likely to be restrained, receive antipsychotic drugs, and suffer poor health outcomes than their counterparts at nonprofit homes. For example, compared with blacks in nonprofit nursing homes with a median (2.4 percent) proportion of black residents, blacks in for-profit nursing homes had twice the likelihood of receiving antipsychotic drugs, whether in facilities with a median (2.4 percent) proportion or a high (10.1 percent) proportion of black residents. For whites who were at low risk of receiving antipsychotic drugs (i.e., those without cognitive impairment or behavior problems), residing in a for-profit nursing home was associated with increased likelihood of receiving antipsychotic drugs. The effect of for-profit status did not vary significantly by proportion of black residents.

There was less use of physical restraints but more use of antipsychotic drugs as racial diversity increased and as nurse staffing ratios decreased in nursing homes. Surprisingly, as the number of nurses per 100 beds increased from 13 to 18, the likelihood of being restrained increased by 14 percent for blacks and by 10 percent for whites. Though counterintuitive, the association between higher restraint use and higher nurse staffing ratios is consistent with some previous studies, note the Brown University researchers. Their study was supported by the Agency for Healthcare Research and Quality (HS10322).

See "Facility and county effects on racial differences in nursing home quality indicators," by Susan C. Miller, Ph.D., M.B.A., George Papandonatos, Ph.D., Mary Fennell, Ph.D., and Vincent Mor, Ph.D., in the December 2006 Social Science & Medicine 63, pp. 3046-3059.

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