Staffing levels likely drive the differences in hospitalizations and emergency department visits among nursing homes, the researchers report in the Journal of the American Geriatrics Society.
Studies show that nursing homes serving high proportions of Black residents may experience poor healthcare outcomes. To better understand the environmental and structural characteristics of nursing homes that may lead to these outcomes, the researchers examined data from 14,121 U.S. nursing homes using multiple national datasets from 2019.
They found that, compared to nursing homes with no Black residents, nursing homes with at least 50% Black residents had lower ratios of registered nurse (RN) and certified nursing assistant (CNA) hours per resident per day and greater ratios of licensed practical nurse (LPN) hours per resident per day. In general, as the proportion of Black residents in a nursing home increased, hospitalizations and emergency department visits also increased.
Nursing homes serving Black residents were also more likely to be located in urban settings, for-profit, located in the South, and have more Medicaid-funded residents.
"As lower use of RNs has generally been associated with increased emergency department visits and hospitalizations of nursing home residents, it is likely that the relative scarcity of skilled workers largely drove the differences in hospitalizations and emergency department visits in nursing homes with greater proportions of Black residents," said Jasmine Travers, PhD, RN, assistant professor at NYU Rory Meyers College of Nursing and the study's lead author.
"Staffing is a modifiable area in which federal and state agencies should take action to eliminate disparities in quality of care among nursing homes," added Travers.
Additional study authors include Nicholas Castle of West Virginia University, Susan H. Weaver of New Jersey Collaborating Center for Nursing, Uduwanage G. Perera of Columbia University School of Nursing, Bei Wu of NYU Meyers, Andrew W. Dick of Rand Corporation, and Patricia W. Stone of Columbia University School of Nursing. The research was funded by the National Institute of Nursing Research (R01 NR013687), National Institute on Aging (K76 AG074922), and Robert Wood Johnson Foundation (77872).
