According to a recent study of nursing homes in Virginia and Maryland, blacks are up to one-third more likely than whites to be hospitalized for dehydration, poor nutrition, bedsores, and other illnesses because they receive less care. In an upcoming issue of the journal Health Services Research, Brown University researchers concluded that in nursing homes which receive substantial Medicaid funding, patients were more likely to be hospitalized because less staff was hired to care for the patients. The study also concluded that the poorest nursing home patients were the most likely to be hospitalized and, the study concluded, racial and economic disparities in care could be eliminated by providing more money to nursing homes that rely heavily on Medicaid funds. Read more about the study.
I look forward to reading this article when it's published. I have no doubt that nursing home and assisted living patients with less -- less money, less life expectancy, less health, less family -- get the worst possible care. If nursing homes and assisted living facilities discriminate against blacks or the poor or the sick by providing less care, it's not just neglect and abuse . . . it's criminal. Nursing homes and assisted living facilities should no more be able to discriminate against patients based on race or payment status than for any other reason. If nursing homes and assisted living facilities are able to discriminate against anybody for any reason, who's safe?
The researchers of this study have important contributions to make in terms of understanding racial and economic discrimination in nursing homes, but I disagree entirely that throwing more taxpayer money at nursing homes is the answer. I also think it's a mistake to suggest that just because a nursing home receives a substantial amount of Medicaid money, it must be a facility with "limited resources."
The researchers need to address deeper questions: Who owned these nursing homes? Did private-pay nursing home patients get neglected and abused as often as patients whose bills were paid by Medicaid? Did nursing home owners skim profits that should have been used to hire more staff and provide better care to all patients? Did these owners intentionally abuse the privilege of receiving Medicaid money by understaffing the facility and shortchanging residents on care? If we pay these nursing homes more, what assurance do we have the money will be wisely spent . . . or spent at all . . . on patient care as opposed to enriching corporate owners? Until we answer these questions, I think the rich will simply continue to get richer and too many patients -- black, white, rich, and poor -- will become victims at the expense of those who abuse our trust.
I think Medicare got it right recently when hospitals were instructed they wouldn't get paid any Medicare money for pressure ulcers (bedsores) and other preventable injuries that occur there. In short, nursing homes must prove they can be good stewards of the money they already receive before we reward them with more.
Posted on Wed, January 16, 2008
by Robert Carter