Recent years have seen an increased—and overdue—focus on structural racism within the United States. The focus on “structural” racism—as compared to legal or explicit racism, for example—responds to ongoing disparities that statistically tend to favor white Americans over people of color and specifically over Black Americans. Like any American institution, the U.S. system of long-term services and supports (LTSS), including nursing facilities, is not immune from structural racism. During the COVID-19 pandemic, we saw an unacceptable number of deaths in nursing facilities, especially among older adults of color. We also saw that older adults of color were more likely to live in poorly performing nursing facilities, and that those facilities were more likely to have a higher death rate than higher quality nursing facilities, which were more likely to have a higher percentage of white residents.
This Justice in Aging issue brief, Racial Disparities in Nursing Facilities—and How to Address Them, reviews relevant research into disparities in nursing facility care in the following areas: admissions, hospitalization of residents, staffing levels, other quality measures, and COVID-19 infections and deaths. The paper then evaluates the implications of that research and offers five policy recommendations to improve Medicaid long-term care in order to better and more equitably meet the needs of all older adults.