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Outcomes
1. Evaluate the current status of palliative care in nursing homes across the United States by varying concentrations of Black and Hispanic residents, respectively
2. Interpret areas of palliative care services to increase provision on nursing homes with higher concentrations of Black and Hispanic residents, respectively, with the goal of advancing health equity
Importance
Approximately one-quarter of all deaths in the United States occur in nursing homes (NHs). Disparities in NH end-of-life (EOL) care are pervasive for Black and Hispanic residents. Palliative care (PC) is essential in providing high-quality EOL care, but more information is needed on the provision on NH PC for Black and Hispanic residents.
Objective(s)
Our aim is to examine the provision of PC services among NHs with varying concentrations of Black and Hispanic residents (aged 65+), respectively.
Method(s)
Cross-sectional analysis of a nationally representative sample of NHs that were surveyed. The survey identified NH PC services (summative score 0 to 100). The survey was linked to Minimum Data Set 3.0 and the Master Beneficiary Summary File (NH resident characteristics) and the Certification and Survey Provider Enhanced Reporting data (NH facility characteristics). Weighted descriptive statistics of PC services and NH facility-level linear multivariate regressions, controlling for percentage Medicaid residents and rurality, were calculated. All models were stratified by census region. NHs were categorized by the concentration of Black and Hispanic residents, respectively (<3, 3-10%, >10%), and all models were stratified by census region.
Results
Our sample included 869 NHs (weighted n = 15,020) nationwide that completed the survey (49% response rate). NHs in the South provided fewer PC services compared to other regions. In adjusted analyses, NHs in the Northeast and West with higher concentrations of Black residents provided significantly fewer PC services. NHs in the West with higher concentrations of Hispanic residents provided significantly fewer PC services.
Conclusion(s)
We observed significant NH PC differences with higher concentrations of Black and Hispanic residents, respectively, and by region.
Impact
The first step in advancing health equity is to identify the inequities, and our findings demonstrate that inequities exist in NH PC services.
Article info
Identification
Copyright
© 2022 Published by Elsevier Inc.
