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Monday, September 9, 2013

And now, in the "no duh" social research news...

If you are unfamiliar the conditions faced by lower income African Americans in general, or with nursing homes in poor black neighborhoods in particular, this might be news to you.  But if you had poor Caucasian parents, like I did, who relied solely on Medicaid for their healthcare all their lives, and then for their long term care as well, then your parents probably lived in a Medicaid-only or predominantly Medicaid-occupied nursing home, like mind did.  And if that was your experience, this article will probably just confirm what you already know to be true.  That poor African Americans, particularly because they are likely to rely on Medicaid and live in nursing homes where most of the residents rely on Medicaid and are also African American, receive worse care than residents in other nursing homes.

For the first six years of her time living in skilled nursing facilities, my mother lived in one of the poorest nursing homes in our county.  The facility was on the south side of the city, in a predominantly black neighborhood, and many of the residents were also black. That facility is now operated under a new name and new management, after having gone belly-up a few years ago.  We moved her into a different facility when the news hit the paper that they were in dire straits. But we had been seeing the problems for awhile. Low staffing ratios, high turnover in the social services department which resulted in staff who were not familiar with my mother's mental illness or concerns, difficulty getting administrators and nurse managers or physicians to take our concerns seriously.  The certified nurses aides were the best thing about that facility, but there were too few of them, and they would leave as soon as they could for work in better facilities.

In the new facility, which was still pretty heavy in terms of Medicaid recipients, but had a resident population that was mostly Caucasian, my mother got better care. No facility is perfect, especially if there are a lot of Medicaid beds, because funding and therefore staffing are always concerns. But she was happier, the nurse managers and social workers were long-term employees and very familiar with her concerns and needs. She spent the last 4 years of her life there (until 1 year ago this week), and was much more content. And when it was time for my Dad to be placed in a facility, he requested to be placed there as well.  And he died there (3 years ago this week, actually), and they took relatively good care of him while he was declining and while he was dying.

So, you can see why the study discussed in this article, which analyzed data collected between 1994 and 2004 from over 11,500 nursing homes across the United States, confirms for me what I already knew on a personal level.  That it's rough being poor and old, or poor and old and mentally ill, and it's even rougher being poor and old and African American.