Demographic and Health Sorting Among Nursing Home Residents

Despite major policy and societal changes over two decades, trends in the demographic and health sorting of nursing home residents remain underexplored. This study focuses on sorting by one demographic factor - race - over time between nursing homes and local communities, and within nursing homes, by another demographic factor - age - as well as health status. Racial sorting is measured using the dissimilarity index, including novel measures of Black, Indigenous, and people of color (BIPOC)/white and Hispanic/white comparisons alongside the established Black/white measure. Racial sorting is higher in nursing homes than in the community for Hispanic/white comparisons, whereas for Black/white and BIPOC/white comparisons, community racial sorting exceeds that in nursing homes. Within nursing homes, racial sorting is highest for Black/white comparisons, higher among older than younger residents, and lowest for those with serious mental illness - possibly reflecting payment source heterogeneity among older residents. Over the study period, overall racial sorting decreased, yet increased within age and health subgroups. These findings underscore the need to understand drivers and consequences of multidimensional sorting in long-term care.