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Nursing Homes Serving Minorities More Likely to Have Coronavirus, Expert Says

Disparity emerges in comparison with homes chiefly serving white residents

A nurse helping a nursing home patient walk down the hallway

ER Productions Limited/Getty Images

En español | Nursing homes in the U.S. serving minority populations have been the hardest hit by infections and deaths from COVID-19, an analysis involving thousands of long-term care facilities by a University of Chicago professor found.

The analysis showed that nursing homes with the fewest white residents were “more than twice as likely to have COVID-19 cases or deaths” than facilities with the highest percent of white residents, said R. Tamara Konetzka, a professor of health economics who has researched long-term care facilities for 25 years.

The work showed a “strong and consistent relationship” between race and the probability of COVID-19 cases and deaths, she said.

Konetzka discussed her findings Thursday, and made recommendations for improving nursing homes during the pandemic, before the Senate Special Committee on Aging. Her testimony was submitted in advance and she also addressed senators at the hearing.

R. Tamara Konetzka

Courtesy University of Chicago

R. Tamara Konetzka, professor of health economics at the University of Chicago

Konetzka noted that the finding that nursing homes with traditionally underserved populations are bearing the worst outcomes during the pandemic “is consistent with racial and socioeconomic disparities in long-term care historically and in pandemic-related deaths currently."

Other key points:

• Because people who need nursing home care usually want to stay close to their home, nursing homes are often a reflection of the neighborhoods in which they are located. Nursing homes serving predominantly nonwhite residents are more likely to be located in predominantly nonwhite neighborhoods and to draw staff from those neighborhoods. As these are the neighborhoods and the people being most affected by the pandemic, nursing homes in these areas are also most at risk.

Nurses and nurse aides in these settings share many of the same vulnerabilities experienced in the communities where COVID-19 is most prevalent. These staff members are predominantly nonwhite, low-income and dependent on public transportation. Many live in families and communities with other essential workers who are unable to work at home and practice social isolation.

• These staff members are more likely to be sick, to have caregiving responsibilities for children or other relatives and to be facing financial hardship. Some fear showing up to work and contracting the virus. Other may come to work despite feeling symptomatic because of a lack of paid sick leave, fear of job loss or a sense of dedication when staff members are desperately needed.

Additional resources are critical, Konetzka said, and these should include paid sick leave, guaranteed coverage of health care costs and hazard pay for nursing home staff. These also may include hotel rooms for nursing home staff who do not want to risk infecting family members, similar to lodging given hospital staffers in many areas.

All nursing homes and other long-term care facilities “are in urgent need of this assistance,” she said, and help should not be delayed “by debates about which facilities could have been better prepared."


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Much at stake for the vulnerable

"There is too much at stake here in terms of the lives and well-being of our most vulnerable older adults,” she said.

And if scarce resources must be prioritized “the most immediate assistance should be provided to nursing homes that serve primarily nonwhite residents where the risk of cases and death are the greatest."

She said temporary “surge teams” may be needed to assist in many nursing homes to stem transmission of the contagion and care for residents critically ill with COVID-19. She also appealed for more personal protective equipment and technical help with infection control.

At AARP, Bill Sweeney, senior vice president for government affairs, said Thursday: “We know this virus can affect people of all races and ethnicities, but there are serious disparities in the outcomes across the country. That's why AARP is urging state and federal leaders to report racial and ethnic data so we can have a clearer picture as we fight to address those disparities throughout the nation."

Data from geographically diverse states

Konetzka's analysis examined coronavirus infections and COVID-19 death data in nursing homes in eight states: California, Colorado, Connecticut, Georgia, Illinois, New Jersey, Nevada and Tennessee.

It also examined infection data alone from nursing homes in three states: Iowa, Massachusetts and Ohio.

Specifically, it looked at:

• The presence or absence of the coronavirus infection at 5,527 nursing homes, with 36 percent of the facilities found to have at least one resident with the coronavirus.

• A smaller group of 3,461 nursing homes to determine if at least one resident had died from COVID-19; that was true for 29 percent of the facilities.

Konetzka is one of the experts who advise the Centers for Medicare & Medicaid Services on its Nursing Home Compare 5-star rating system on nursing-home quality.

Interestingly, the analysis found no meaningful correlation between nursing home quality, based on the star rating system, and the probability of at least one COVID-19 case or death, she said.

The first reported COVID-19 death in the U.S. occurred in Washington state in a facility with a 5-star rating, she noted.

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