En español | Nursing homes with a higher proportion of Black and Hispanic residents reported more than three times as many COVID-19 deaths as homes with more white residents, according to a new national study. Nursing homes with more than 40 percent minority residents reported coronavirus case and death counts that were 3.3-fold higher than facilities with more than 97 percent white residents.
Black Americans are more commonly admitted to facilities with “lower nurse staffing ratios, more serious regulatory deficiencies, and a higher likelihood of being terminated from the Medicaid program,” researchers wrote in the study.
"Non-White residents are more likely to live in facilities that are larger, which creates more opportunity for viral transmission,” they continued. “COVID-19 is more prevalent in non-White communities, and community spread is a factor associated with cases and deaths in nursing homes.” Minority residents, they said, are “in the eye of that perfect storm."
The study, conducted by a team at the University of Chicago, was published Wednesday in JAMA Network Open, a journal of the American Medical Association.
In the United States, minority populations have been disproportionately affected by COVID-19, and nursing homes and other long-term care facilities, such as assisted living residences, account for 36 percent of the more than 475,000 U.S. COVID-19 fatalities. Less than 1 percent of the population lives in long-term care.
But few studies have focused on the intersection of these two populations, says AARP's Elaine Ryan, vice president of state advocacy and strategy integration. “The study is critically important,” she explains, “because it is the first type of data and insights that show how vulnerable these minority populations in the facilities really are.”
"The findings are devastating,” Ryan adds. “They show that there's structural racism and inequality in long-term care and immediate action must be taken to get these residents more help and support."
Hope from coronavirus vaccinations
The study analyzed data that more than 13,000 federally certified nursing homes submitted to the Centers for Disease Control and Prevention (CDC) through mid-September. The researchers said that the unequal effects of COVID-19 in nursing homes stem from historic disparities in the facilities and that prioritization of long-term care staff in coronavirus vaccinations is offering much-needed hope.
Under a federal partnership, CVS, Walgreens and other pharmacies sent teams to long-term care facilities to administer vaccines from Pfizer and Moderna to residents and staff ahead of the U.S.’ broader public vaccination effort. The drugstore chains finished their first round of on-site clinics in all participating nursing homes in late January and are in the midst of completing their second-round clinics.
Around 78 percent of residents accepted their offer of a vaccination shot ahead of almost everyone else in America during these first-round clinics; only 37.5 percent of staff did so, according to the CDC.
"As vaccination proceeds, it will be important for policymakers to consider existing inequities to ensure that the process of vaccine distribution includes particular efforts to reach communities of color,” the study states.
AARP's Ryan says such efforts need to go beyond prioritizing the nursing home community for vaccinations and also include better education and outreach to minority populations on the safety and efficacy of the shots. “Their concerns are rooted in a history where they haven't been prioritized,” she observes. “In fact, it's been the opposite in many cases, and they've been ignored or mistreated. So we must listen to their questions — they're real and they're important.”
The study's authors note several limitations, including that the data did not allow for racial classifications other than white, Black and Hispanic. “More detailed data on race and ethnicity are needed to examine whether there are differences in COVID-19 outcomes among the diverse non-White groups,” the researchers wrote.