Nursing Home Abuse and Neglect Higher for African American Residents

I have recently come to a sudden realization: almost all of my nursing home negligence clients are minorities. Specifically, somewhere around 85% of my nursing home negligence clients have been African American. I have not found the same statistical anomaly in my medical malpractice or auto negligence clients. This led me to investigate whether African Americans receive disparate treatment in nursing homes, which would account for a higher rate of injury.

Thousands of baby boomers turn 65 every day. As a result of that, the U.S. is in a long-term care crisis. By 2050, the number of African Americans age 65 and older will more than triple, and the number of older Latinos will increase 11-fold. Curiously, between 1999 and 2008, the number of white people in nursing homes decreased despite the aging population. During the same timeframe, the number of African Americans in nursing homes increased.

A 2011 analysis published in the journal Health Affairs suggests that elderly minorities are gaining access to nursing care, but that is occurring because they do not have the same access to care as whites. The author of the study, Zhanlian Feng, was quoted as saying nursing homes are the “last resort,” and that most people who can pay prefer to stay at home. Mr. Feng’s study looked at 14,374 nursing homes and 1,466,471 residents and measured segregation and disparities in care quality.

Mr. Feng’s study found in 2000 that black residents were concentrated in a small percentage of nursing homes, with more than 50 percent of black residents in for-profit homes concentrated in less than 10 percent of for-profit facilities. More than 70 percent of nonprofit residents were concentrated in under 10 percent of nonprofit facilities. That is extreme segregation. And that segregation carries dire consequences.

Mr. Feng’s study further found that black nursing home residents were:

  • 1.31 times as likely to be in a facility in the highest quartile of homes in terms of total severity-weighted deficiencies.
  • 1.41 times as likely to be in a facility cited with a deficiency; and
  • 1.70 times as likely to be in a nursing home that was subsequently terminated from Medicare and Medicaid participation.

There is a well-researched consensus in literature that minority elders do not receive nursing home care of comparable quality to white people. According to a 1999 study, black people had a 63% greater probability of being untreated for pain relative to whites within a study of elderly cancer patients. Black people were also concentrated in facilities with lower ratings of cleanliness, maintenance and lighting in a study of nearly 250 nursing homes and assisting living facilities. Black nursing home residents are more likely to be hospitalized, and more likely to be admitted to nursing homes with high deficiency ratings. The national data show that nine percent of whites reside in “low-tiered facilities” compared to forty percent of African-Americans that reside in ‘”low-tiered facilities.”

Pressure ulcers are a common problem among nursing home residents. Pressure ulcers, also known as “bedsores” are areas of skin breakdown caused by excessive pressure, moisture, or friction. Pressure ulcers are a common sign of poor care, and generally occur because a nursing home resident is left to sit in the same spot for too long. Pressure ulcers can cause permanent disfigurement, infection, or death.

Black nursing home residents show persistently higher rates of developing pressure ulcers than white residents. One study showed that black nursing home residents had a rate of developing pressure ulcers of 16.6% while white residents developed them at a rate of 11%. The study was based on data from 2003 – 2008 from nursing home Minimum Data Set (MDS) files. The MDS is a nationally mandated tool for patient assessment and care planning in all nursing homes certified by the CMS. Over 90% of nursing homes in the US are so certified. Of white residents, 10.5% had pressure ulcers of stage 2 or higher; and of Black residents, 15.9% had pressure ulcers of stage 2 or higher, resulting in an overall unadjusted racial difference of 5.4%.

White and black nursing home residents with the highest concentration of blacks had at least a 30% increased risk of pressure ulcers. The study could not determine why nursing homes with a large percentage of black residents were associated with higher risk for pressure ulcers. The study’s authors controlled for managerial, staffing, financial and geographic characteristics, so the problem was clearly one of race.

State Medicaid programs are the dominant force of funding for nursing homes, providing roughly half of total payments for long-term care. The second largest source of funding is Medicare. Those with the ability to pay generally prefer home care or community-based care in an assisted-living facility. This means that poor people end up in nursing homes, while rich people stay at home or in posh assisted-living facilities, where the population is generally less ill and more staff are available to care for the residents.

Nursing homes with fewer private-pay patients will tend to have lower nurse staffing levels and more serious inspection deficiencies. This creates dangerous incentives for nursing homes. First, businesses looking to invest in nursing homes may avoid poor, minority neighborhoods, understanding they will not have many private pay patients. Nursing home owners may also control admissions to their facility by limiting the number of public benefit patients it accepts. This would result in a concentration of poor minorities in the worst nursing homes.

Recently, a Maryland nursing home company, NMS Healthcare, made headlines by being sued by the state attorney general for engaging in a practice known as “patient dumping.” The facility would discharge patients, frequently with nowhere else to go, once Medicare stopped paying for their care and Medicaid would kick in. This is because nursing homes get reimbursed at a higher rate by Medicare and private insurance than Medicaid.

Structural inequalities certainly play a role in the care disparity among nursing home residents. The racial composition of nursing homes is, in large part, a reflection of the segregation in residential neighborhoods. In my own personal experience, more nursing home negligence claims come from Prince George’s County, Maryland, an area with a high African American population, than Montgomery County, Maryland.

Experts in racial disparities in healthcare recommend a multi-prong approach to address the problem, including increasing Medicaid payment rates and ongoing monitoring and enforcement of civil rights laws. Title VI of the Civil Rights Act may hold a remedy. Title VI forbids anyone receiving federal funds from discriminating on the basis of race. This would include nursing homes, as they are funded mostly by Medicaid and Medicare.

If you have questions or concerns regarding a loved one’s treatment in a nursing home, search The African American Attorney Network database for an attorney in your city or state that may be able to assist you.  


About the Author: Peter Anderson is a partner with Ketterer, Browne & Anderson, a firm that handles cases nationwide, and is dedicated to representing consumers injured by corporate greed. Mr. Anderson has successfully handled dozens of nursing home negligence cases against several multi-billion dollar corporations. Mr. Anderson takes pride in succeeding in cases where other lawyers have declined representation. Mr. Anderson resides in Northern Virginia, but is originally from Ithaca, NY. Mr. Anderson graduated from the University of Michigan with a degree in psychology and went on to obtain his law degree from the George Washington University Law School. He can be reached at 703-215-2994 or