Access to long-term care: race as a barrier

Area of Science:

• Health Services Research
• Health Equity
• Sociology of Health

Background:

• Racial disparities in healthcare access are a persistent issue, affecting both acute and long-term care.
• Previous observations indicated whites utilized more nursing home care days than nonwhites, even when Medicare covered costs, suggesting factors beyond payment source.

Purpose of the Study:

• To examine racial differences in hospital discharge delays for patients awaiting long-term care placement.
• To identify if race independently influences the time between a patient being medically ready for discharge and their actual discharge.

Main Methods:

• Analysis of data from patients in North Carolina acute care hospitals in 1991 awaiting alternative placement.
• Utilized logistic regression, ordinary least squares, and two-way analyses of variance to assess factors associated with discharge delay.
• Controlled for variables including payment source, medical needs, demographics, and discharge planning challenges.

Main Results:

• Race was found to have substantial independent explanatory power for discharge delays.
• Even after controlling for numerous patient characteristics and logistical factors, racial disparities in discharge timing remained significant.
• The findings suggest that nursing homes discriminate in patient admissions based on race.

Conclusions:

• Nursing homes exhibit racial discrimination in patient admissions, leading to prolonged hospital stays.
• This discriminatory practice incurs direct costs for hospitals and society due to delayed discharges.
• Further research is recommended to ascertain the national prevalence of these findings, though existing literature suggests the problem is widespread.