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Racial Disparities in Nursing Home Care in Illinois

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The COVID-19 pandemic brought incomparable devastation and despair to the nation’s nursing homes, revealing preexisting racial disparities in the industry. Black and Brown Illinoisians in long-term care bore the brunt of the virus’s wrath. Our state’s nursing home residents should receive the quality care they deserve, regardless of race or ethnicity.

COVID-19 has killed over 200,000 residents and staff in nursing homes and other long-term care facilities in the US, according to the Centers for Disease Control. These deaths account for a staggering 23% of pandemic fatalities, yet the death toll in nursing homes with higher proportions of non-white residents was especially catastrophic. During the first wave of the pandemic in Illinois, Black and Brown Medicaid residents in nursing homes were 40% more likely than white Medicaid residents to die from the virus.

The state’s Department of Healthcare and Family Services (HFS), which published those findings, identified various structural factors contributing to the deadly disparities in Illinois, but the problem of racial disparities in nursing home care—and health care overall—existed long before the pandemic.

From Jim Crow to redlining to Tuskegee, a long history of disenfranchisement and medical distrust has left racial and ethnic minorities with significant barriers to quality health care. According to the 2021 National Healthcare Quality and Disparities Report, people of color experienced “significant disparities in all domains of healthcare quality,” including poorer access to preventative services and screenings to diagnose and manage chronic conditions. The comparative lack of early treatment availability for communities of color creates a domino effect of adverse health outcomes for otherwise treatable conditions. For example, the rate of end-stage renal disease among Black patients with diabetes is more than double that of white patients.

Before we discuss recommendations for closing the racial gap in nursing home care, let’s return to the original question: What factors cause Black Americans in long-term care to suffer greater healthcare burdens compared to their white counterparts?

First, nursing homes in Illinois and around the country are highly segregated by race. Compared with white residents, Black nursing home residents are more likely to live in facilities that primarily serve people of color. For example: 

  • 16% of the state’s nursing home facilities have no Black or Brown residents
  • 68% have less than that statewide average of non-white residents
  • In 14% of facilities, 50% or more of the residents are Black or Brown

The HFS report notes, “Very few nursing homes have a racial make-up mirroring the state as a whole.”

As expected, this segregation negatively affects residents’ quality of care. Studies consistently show that nursing homes with higher proportions of non-white residents have lower quality scores on government inspections. They are more likely to have lower staff-to-patient ratios, to be cited for deficiencies in the quality of care they provide, and to suffer from higher rates of abuse and neglect.

In the case of COVID-19, the most significant contributing factor to higher death rates was the one most connected to viral transmission: Black residents were “more than twice as likely to be in a facility that is heavily dependent on room crowding.” That factor alone was especially deadly in facilities where social distancing was practically impossible.

Recommendations for Policymakers & Families

While there is no single solution to closing the racial gaps in nursing home care, various advocacy organizations offer several recommendations to improve the quality of care for residents of color. These include:

  • Improved data collection, transparency, and increased accountability for long-term care providers.
  • Ending overcrowding of nursing home rooms with three or more beds.
  • Greater transparency of nursing home ownership and revenue.
  • Restructuring the nursing home industry away from for-profit ownership of nursing homes toward not-for-profit managed care organizations.
  • Reforming Medicaid reimbursement models emphasizes the quality of care over the volume of services provided.

For families concerned with the quality of care in their loved one’s nursing home facility—here are key warning signs of potential abuse and neglect:

  • Bedsores
  • Frequent falls
  • Unexplained injuries, including bruises, cuts, or broken bones
  • Unsanitary living conditions, such as soiled bedding or a foul odor in the room
  • Signs of dehydration, like frequent UTIs
  • Sudden changes in mood or behavior, such as withdrawn behavior or paranoia
  • Unexplained or sudden weight loss 
  • Because many nursing home residents have physical or mental limitations, it can be hard for them to advocate for themselves. Keeping a close eye on their condition and knowing your rights as a family member are key. 

Does your loved one in a nursing home show signs of abuse or neglect? If so, it’s important to talk to an experienced nursing home abuse and neglect lawyer to explore your legal options. An attorney can investigate a potential abuse claim, and will have the resources to go up against large, for-profit nursing home corporations. 

Black members of our community are disproportionately affected by poor nursing home care. The attorneys at Levin & Perconti are committed to protecting and vindicating the rights of people who have been injured due to systemic flaws. Our message is clear: abuse and neglect won’t be tolerated. It’s part of our mission to get justice for people of color in Illinois and beyond. Holding these large institutions accountable is how we create change. 

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