5% Fewer Available Beds In Nursing Homes, Poor Communities Most Badly Affected

The large number of nursing home closures between 1998 and 2008 resulted in 5% fewer available beds, with minority and poor communities suffering considerably more than other communities, researchers from Brown University revealed in Archives of Internal Medicine.

As background information, the authors wrote:

“Regulatory oversight, reinforced by market forces and an increased focus on transparency and public reporting, is designed to eliminate poorly performing nursing homes. A small fraction of U.S. nursing homes closes each year (not more than 2 percent). Perhaps this is a desired outcome, since closure is the ultimate indicator of performance failure. However, the operation of regulatory efforts and market forces are not likely to result in random distribution of closures.”

Zhanlian Feng, Ph.D., and team gathered and examined data from a nationwide database of Medicaid/Medicare-certified nursing homes in America between 1999 and 2008. Details on 18,259 unique nursing homes throughout the whole of the country were analyzed. They used data from the 2000 US census to define geographic boundaries and track down nursing home closures by state, metropolitan statistical area and zip code. Then they tallied closures to zip code-level population data on poverty, racial and ethnic composition.

2,902 nursing homes shut down during that ten-year period – nearly 16% of all Medicare/Medicaid certified facilities. 1,776 nursing homes (11% of total) were freestanding and 1,126 were hospital-based. A net-loss of 5% of all nursing home beds.

Zip codes with the highest number of African-Americans had a 38% higher relative risk of closure of freestanding facilities compared to those with the lowest number of African Americans (top fourth of zip codes vs. bottom fourth of zip codes). Likewise, the zip codes with most Hispanics had a 37% higher risk compared to those with the fewest Hispanics.

Areas with the highest poverty rates were twice as likely to have had closures compared to areas with the lowest rates.

The figures for hospital-based facilities were similar.

The investigators wrote:

“Since most failed nursing homes experience a downward spiral in financial and quality performance before their eventual closure, one might argue that the demise of such facilities is not necessarily a concern. However, in the broader context of structural and socioeconomic disparities and persistent racial residential segregation, the clustering of nursing home closures in poor and minority- concentrated urban neighborhoods is troubling. This phenomenon, arguably, resembles similar dynamics of inequalities in public schools, housing, environmental decline and other sectors.

(Conclusion) The cumulative loss of nursing facility beds in the aftermath of closures, combined with the lack of alternative long-term care services in these disadvantaged communities and increasing use of nursing homes among minority elderly people, suggests that disparities in access will increase.”

Arch Intern Med. Published online January 10, 2011. doi:10.1001/archinternmed.2010.492.