A Comprehensive Guide: Addressing Racial Disparities in Long-Term Senior Care

Key Takeaways

  • Racial disparities in long-term senior care are a significant public health issue, leading many racial minorities to avoid or delay seeking care.
  • Economic challenges and early-life discrimination can prevent individuals from saving for long-term care, affecting their health status when they need it.
  • Black and Latino Americans often face discrimination in healthcare, affecting their trust in the system.
  • Older people of color have higher mortality rates and are more likely to be mistreated in nursing homes, reducing their quality of life.
  • Addressing disparities requires measures like staff bias training, a diverse healthcare workforce, and culturally informed services.
  • Black and Latino populations in nursing facilities saw higher COVID-19 infection and death rates.

Racial disparities in healthcare, including in long-term senior care, are a serious public health issue and are still more common than people may realize.

These disparities play a large role in the overall health of racial minorities, as people in minorities may receive inadequate care, avoid or delay seeking care, and even find their medical conditions worsened from the stress that these disparities cause.

By addressing these racial disparities and improving the standards of care for seniors in all demographics, regardless of their race or ethnicity, more seniors will have access to the long-term care they need and deserve.

How Do Racial Disparities Affect Long-Term Care?

Research shows that racial health disparities affect certain minority groups and populations more than others, and that they are typically affected throughout their entire lives.

Economic hardships or racial discrimination in the workplace that a person experiences when they are younger may prevent them from being able to save for their long-term care as they age.

Furthermore, if they experience racial discrimination in healthcare throughout their lives or cannot afford healthcare due to poverty, this could in turn affect their overall state of health when entering long-term care and the level of care that they require.

Long-Term Care Support System Favors White Older Americans

In America there exists a form of unspoken “structural racism”, which allows for a certain level of racism or segregation to exist in societal structures such as the education or healthcare system.

This extends into long-term care, where White individuals benefit over racial minorities and particularly over Black individuals.

Research suggests that not only do Black Americans tend to reside in long-term care facilities of lower quality than White Americans, but they also receive poorer-quality care than their White counterparts from within the facilities.

High Number of Deaths Among Older People of Color

Along with a support system that does not favor them, older people of color experience a higher number of deaths than White seniors — a result of decades of poor-quality health care.

Within nursing homes, older people of color are also more likely to be mistreated and have their calls for help ignored, and are thus left with a poorer quality of life and life expectancy.

Decline of Functional Ability Leading to Caregiver Burden

In addition to experiencing an overall shorter lifespan, seniors in racial and ethnic minorities also tend to experience a heavier decline in functional ability as they age.

This functional decline can add to financial hardships and contribute to caregiver burden and burnout as seniors of color need to be moved more quickly through more attentive levels of care.

Who Is Most Affected by Racial Disparities in Senior Care?

According to the Catholic Health Association in Washington, DC, 22% of long-term care residents were from racial minorities as of 2015, with this number expected to reach 39% by 2050.

In terms of racial disparities in senior care, Black Americans and Hispanic Americans are the most commonly affected groups.

Black Older Americans

Black older Americans are the group that is most affected by racial and ethnic disparities in healthcare and other structures.

With Black Americans, financial and clinical status plays a large role in mistreatment and discrimination.

Statistics for Black Americans and healthcare disparities include:

  • 56% of Black Americans report having had at least one negative experience in a healthcare setting.
  • 63% of Black Americans list a lack of access to quality medical care as a major cause for the healthcare inequities they experience.
  • 12.1% of all Black Americans under the age of 65 have no form of health insurance.

Latino Older Americans

Latino Americans face racial disparities at a rate similar to Black Americans, with some similar reasons but also a few key differences.

With Latino Americans, many of the fears revolving around medical treatment and healthcare involve language barriers or a person’s legal status.

These barriers may result in a Latino person avoiding care for fear of conflicts of interest from their healthcare providers, even if unintentional.

Statistics for Latino Americans and healthcare disparities include:

  • Three out of every 10 Hispanic adults say that they know someone who is concerned about their legal status being compromised when seeking medical care.
  • 44% of Latino Americans list communication problems or a lack of English proficiency as a major barrier in receiving adequate healthcare.
  • 20% of Latino Americans under the age of 65 lack health insurance.

Other Ethnic Groups

Other ethnic groups in the US who report healthcare disparities and discrimination are Asian Americans, American Indians, and Alaska Natives.

Statistics for other ethnic groups and healthcare disparities include:

  • Asian Americans and Pacific Islanders are the group least likely to have a primary care physician and one of the more likely groups to skip doctor appointments.
  • American Indian and Alaska Natives are twice as likely as non-Hispanic Whites to not have any health insurance coverage.
  • American Indian and Alaska Native women are three times more likely than non-Hispanic White women to receive delayed or no prenatal care.

Racial Disparity Barriers Seniors May Face in Long-Term Care

There are a multitude of barriers that seniors in racial minorities face when seeking long-term care.

Unfortunately, most of the current research that exists on racial disparities in healthcare focuses on comparisons across senior care facilities, and less is known about the racial disparities that occur from within them.

Barriers to Admission to High-Quality Facilities

A major focus of the research on racial disparities in long-term healthcare facilities focuses on the rates at which individuals of specific races are admitted into long-term care and the types of facilities that they are admitted to.

Key takeaways include:

  • A 2006 study found that Black hospital patients were more likely than White patients to be admitted to a nursing facility in the bottom 25% of quality ratings.
  • A 2018 study found that 80% of Black hospital patients were admitted to a subset of 28% of nursing facilities, while 80% of Latino patients were admitted to a subset of 20% of nursing facilities.
  • A 2021 study further confirmed that Black hospital patients were less likely to be admitted to nursing facilities of high quality than White patients.

These disparities in care could often not be explained by or attributed to a patient’s financial or clinical status.

Lack of Appropriate Healthcare Services

African Americans surveyed by Pew Research Group cite the biggest health inequity that they experience as being a lack of access to health services.

Long-term care in particular can be very expensive, costing up to $10,000 per month for some skilled nursing facilities, and is often not covered by insurance.

These costs are out of reach for many older minorities in the U.S., added to the fact that many of them live in urban or rural areas and may also lack reliable transportation.

Inadequate Staffing Levels & Lack of Trained Staff

One important way that the quality of a senior care facility can be measured is by the amount of specialized staff that they have, the type of training their staff has, and their overall ratio of staff to patients.

Further research has been conducted, particularly in the past 10 years, to examine staffing level disparities across nursing facilities.

Key takeaways include:

  • While there has been an overall rise in the level of registered nurses (RNs) employed by nursing facilities in the past 10 years, this increase is less prominent in nursing facilities that are predominantly populated by seniors of racial or ethnic minorities.
  • Nursing facilities that are predominantly White in population have a staffing level of RNs that are 34% to 60% higher than facilities with mostly Black or Latino populations.
  • Nursing facilities that have higher populations of racial or ethnic minorities also have a lower nurse skill mix and less experienced nursing staff in general.

Furthermore, these disparities could not always be attributed to a facility’s location, the level of care provided by them, or their percentage of Medicaid-eligible residents.

Lack of Standard of Care

Additional research during this time period shows that a lack of standard of care has resulted in mistreatment of individuals in racial or ethnic minorities in long-term care facilities.

Key takeaways include:

  • Black residents are more likely to be subject to physical restraints than White residents and also to have antipsychotic medications used on them during hospitalizations.
  • Black residents experience pressure sores (bedsores) at a higher rate than White residents, suggesting they receive less attentive care.
  • Black residents report a lower quality of life than White residents, regardless of the racial makeup of their individual facility.

In addition to a lack of standards of care, sometimes there are instances where standards of care are incorrect.

An example of this is a common belief that was once taught in medical schools that African Americans have thicker skin and therefore experience less pain than Whites, a belief that has led to unsafe and inhumane practices in the past.

Inadequate Care for COVID-19 Infection & Other Diseases

Black and Latino populations experience certain infections and diseases at disproportionate rates when compared to White populations — a fact that was brought more publicly to light by the recent COVID-19 pandemic.

Key takeaways include:

  • Increased numbers of COVID-related infections and deaths took place in nursing facilities with larger Black and Latino populations.
  • Black and Latino nursing facility staff members were less likely to be allowed to telecommute to work to avoid contracting or spreading infection.
  • Increased COVID deaths in facilities with more racial minorities were partially attributed by researchers to larger facility size and an overall poorer quality of care.

Discrimination Against Residents on Medicaid

Research also strongly suggests that people who are on Medicaid face the highest levels of discrimination, mistreatment, and abuse in senior care.

Unfortunately, this means that it is disproportionately minorities who suffer, as they represent 61.1% of all Medicaid recipients in the U.S., according to the Medicaid and CHIP Payment and Access Commission (MACPAC).

Risk Factors for Experiencing Racial Disparities in Senior Care

People of color tend to experience racial disparities in senior health care because of certain risk factors that are often present throughout their lives.

Economic Hardship

Long-term care can be very expensive, and often requires people to save for many years and frequently put money away into their savings well in advance.

Certain racial populations, such as African Americans and Latinos, struggle with unemployment or poor job opportunities (often due to discrimination) throughout their lives. And this financial hardship can prevent them from affording the long-term care they need later on.

Lack of Adequate Preventative Care

While experiencing financial hardship throughout their lives, many racial minorities also experience a lack of adequate medical care, including preventive care.

In turn, they may be more likely to suffer from chronic illness or be more susceptible to infections or other serious illnesses during their time in nursing care.

Systemic Healthcare Discrimination

Discrimination in healthcare happens all around the world, including in the United States, where African Americans have a consistently lower life expectancy than Whites.

Examples of systemic healthcare discrimination include:

  • Healthcare providers who discriminate or harass people of color, either openly or privately
  • Healthcare facilities or programs that do not offer anti-discrimination policies
  • Senior care facilities that offer unequal care and levels of attention to residents of different races, whether intentionally or unintentionally
  • Healthcare providers who ignore or dismiss the symptoms or concerns of people of color

Stressors Related to Discrimination

Racial minorities are also likely to experience stressors related to discrimination, stressors which may prevent them from seeking care at all.

These stressors can grow into severe mental health conditions like depression and anxiety, and even result in physical conditions that affect a person’s overall health.

Further, research has shown that perceived discrimination can be just as harmful and stressful as actual discrimination.

Lack of Adequate Care for Chronic Illness

Chronic illnesses tend to be well-managed in older White Americans, while the same is not true for racial minorities, and particularly older Black Americans.

Hence, a White person with the same illness as a Black person will likely receive better care throughout the course of the illness, translating into a better life expectancy and overall quality of life.

Effects of Racial Disparities on Older Americans Seeking Long-Term Care

Racial disparities can have many effects on older Americans seeking long-term care, effects which can translate into both the short term and long term.

Mistreatment & Abuse of African American Elders

Racial disparities can turn into mistreatment and abuse if left unaddressed in healthcare institutions, and African American elders are the ones who often suffer the most.

According to the National Center on Elder Abuse, two of the more common types of abuse that African American elders experience are financial exploitation and psychological mistreatment.

Mistreatment & Abuse of Latino Elders

Low-income immigrant Latino elders also face an elevated risk of elder abuse, including psychological, physical, and sexual abuse.

In fact, a study in the Journal of the American Geriatrics Society found that 40.4% of Latino elders had experienced abuse or neglect within the past year of taking the survey.

One major reason this occurs is because of a lack of language proficiency and an inability to speak up for oneself as a result.

Worsened Health Status Over Time

Chronic medical conditions are, in general, more common in seniors of racial and ethnic minorities than they are in those of non-hispanic White populations.

As these groups often receive poorer quality medical care prior to and during their time in long-term care, their overall health status is likely to decline at a fast and higher rate.

Dissatisfaction With Long-Term Healthcare

According to the Commonwealth Fund 2021 International Health Policy Survey of Older Adults, more than 2 in 5 respondents who reported experiencing racially motivated discrimination also reported being dissatisfied with their care.

This is double the rate of dissatisfaction among respondents who did not report discrimination, suggesting that discrimination plays a large role in a patient’s level of satisfaction overall.

Reports of Seniors Being Treated Differently Due to Race

Seniors of racial or ethnic minorities often report being treated differently in healthcare settings due to their race, with African American females being the most common group with this complaint.

In fact, the same Commonwealth Fund survey from above found that nearly half of African American women report feeling treated differently by healthcare providers as compared to only a quarter of White men who feel the same.

How to Reverse Racial Disparities in Long-Term Care

Racial disparities in long-term care can be reduced by certain actions from health care providers and communities.

Ease the Process of Reporting Healthcare Discrimination

As of now, many seniors may be unfamiliar with the process of reporting healthcare discrimination, or they may not be aware that they have such an option.

By making this process easier and more available to seniors, less and less cases of healthcare discrimination may go unreported or ignored.

Educate Healthcare Professionals on Racial Disparities

It is important that healthcare professionals are educated about racial disparities in healthcare while they are still in medical school and before they start practicing medicine.

This can help ensure that they are armed from the start with the proper knowledge to treat patients of all racial backgrounds and promote health equity within their facility.

Look for Healthcare Policies That Allow Racism

Some existing healthcare policies may still allow for racism to exist, many times without intention or realizing that it is happening.

By looking for and identifying these policies in healthcare that still allow racism, prejudice, or bias, they can be addressed and changed to be more appropriate and affirming for all.

Promote a Diverse Healthcare Workforce

Promoting a diverse healthcare workforce means diversity and inclusivity can be extended down to patients as well, and foster an overall sense of cultural competence.

A diverse and open-minded staff is also more likely to provide welcoming and warm feelings to all senior residents, regardless of their race or ethnicity.

Offer More Culturally Informed Healthcare Services

Culturally informed healthcare services are those which value and respect the culture of each individual patient and their family and are able to integrate these beliefs and practices into their care.

Healthcare services that are culturally informed can improve outcomes for patients, as well as result in greater overall patient satisfaction and comfort.

Change Facility Requirements for Medicaid Certification

Currently, partial certification rules for Medicaid allow facilities to designate certain rooms as Medicaid-eligible and thus limit the number of Medicaid-eligible residents that they accept.

This practice also allows long-term care facilities to evict residents when they no longer qualify for or can pay for the room in which they reside.

Complete Medicaid certification for facilities would instead allow more Medicaid-eligible residents and also create more equality within facilities by ending the structural segregation that occurs from having designated rooms or areas.

Improve Staffing Issues

Facilities that have a high amount of nursing home residents who are of racial minorities tend to be of lower quality and have higher staff-to-resident ratios.

The staff in these facilities may also be less trained or educated and only possess the minimum certifications and experience required for their position.

Some of these issues can be improved by hiring more staff members and also requiring specialized training as part of their employment requirements.

Offer Bias Training for Facility Staff

Unconscious bias-training aims to make employees more aware of any racial biases that they have, all in an environment that is judgment-free.

Once facility staff members are made aware of their biases they can work toward changing them and eliminating any discriminatory behaviors they participate in.

Resources for Seniors Facing Racial Disparities in Long-Term Care

Seniors have several resources available to them when it comes to facing racial disparities in long-term care, as well as general medical care resources and financial resources.

Medical Care Resources

The following resources are available to assist seniors and people of all ages who have experienced healthcare or medical disparities due to their race or ethnicity.

Medical resources for seniors facing racial disparities include:

  • National Institute on Minority Health and Health Disparities: this large resource for research programs and grants related to minority health and health disparities is an organization dedicated to improving health outcomes for all minorities.
  • Quality check from The Joint Commission: this tool allows people to search for quality health care organizations that have received accreditation from The Joint Commission, which is dedicated to overseeing proper standards of care in healthcare facilities.

Long-Term Care Resources

Seniors of minority races and ethnicities also have resources available when facing racial disparities in long-term care or retirement.

Long-term care resources for seniors facing racial disparities include:

  • The National Consumer Voice for Quality Long-Term Care: this organization provides a variety of resources to seniors seeking quality long-term care, with a mission of advocating and empowering individuals in long-term care and their families.
  • Diverse Elders Coalition: this organization mainly advocates for Alaska Natives and American Indians on issues of aging but has numerous partner organizations for different minorities such as the National Caucus and Center on Black Aging (NCCBA), and the National Hispanic Council on Aging (NHCOA).

Financial Resources

There are also financial resources available to racial and ethnic minorities who have faced disparities in healthcare or long-term care.

Financial resources for seniors facing racial disparities include:

  • Medicaid: a type of state-funded insurance that is open to pregnant women, children under 18, disabled people, and adults over the age of 65.
  • Medicare: another type of state-funded insurance that is open to people 65 and older, and which can be used toward some types of long-term care when care is medically necessary and other criteria are met.

Find Help for Seniors Looking for Unbiased Long-Term Care Facilities

Seniors who are part of racial or ethnic minorities and who are seeking unbiased long-term nursing home care can contact us at any time with questions or to seek guidance.

We can connect you with resources and information on how to proceed if you have been the victim of discrimination or elder abuse.

Additionally, you can also browse through our comprehensive directory of senior apartments, independent living communities, assisted living facilities, and skilled nursing homes at any time.

Everyone deserves senior care that is high-quality and which makes them feel seen, valued, and cared for — please do not hesitate to reach out to us today to find inclusive housing options.

Written by: Aging with Care Editorial Staff

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