In nursing homes, black residents receiving worse care than white residents

The Chicago Reporter did an investigation revealing poorer ratings for majority-black homes in Illinois than majority-white homes:

An investigation by The Chicago Reporter found that Illinois is arguably the worst state in the nation for Black senior citizens seeking quality nursing home care. There is just one home in Illinois rated “excellent” by the federal government when more than 50 percent of the home’s residents are Black. In Illinois, these facilities get the worst federal ratings and on average have more violations than facilities where a majority of residents are white. And in Chicago, on average, these homes have more medical malpractice and personal injury lawsuits. People in white homes got better care than those in Black homes, even if both were poor.

The Reporter also found that the staff at Illinois’ black nursing homes spent less time daily with residents than staff at facilities where a majority of the residents are white. Of that time, Black residents got a smaller percentage of time with more-skilled registered nurses than facilities where the residents were white […]

The Reporter analyzed the records of 15,724 nursing homes listed in the federal Nursing Home Compare ranking database to determine if disparities existed in the quality of care. The overall rating is based on a combination of health inspection results, staffing levels and how well each home performs on 10 important aspects of care, like how well residents maintain their ability to dress themselves and eat. The database includes homes that get some of their money from Medicaid or Medicare, more than 95 percent of all nursing homes.

The Reporter found that in Chicago, the worst rating—a one on a five-point scale—was given to 57 percent of Black nursing homes, compared with 11 percent of white nursing homes.

Excellent ratings were given to no black homes in Chicago and 29 percent of all homes with majority-white residents. White seniors had qualitatively better nursing home options than Black seniors—in some cases, even when facilities had the same owner […]

The Reporter analyzed the ratings for Chicago homes where more than 75 percent of residents’ care was paid for by Medicaid. A quarter of white homes received an excellent rating, compared with none of the black homes. More than half of the Black homes received the worst rating, while 8 percent of white homes earned the same score […]

“That’s blatant racism,” [state Rep. LaShawn Ford] said. “A lot of the times the owners of these nursing homes treat them [just] as a business. It has to be more of a mission than a business.”

It should be surprising, but it’s not. In just about any way you can identify, it appears that black people are receiving worse care than white people. We can talk about the causes — the value society has placed on particular qualities in a person, the significantly worse performance of for-profit homes — in this case, it even appears that the systemic effect of poverty (which black people suffer under disproportionately) made no difference; poor black people still received worse care than poor white people.

We can talk about support for independent living for people with disabilities, but that is a point where poverty — especially poverty extending deep into a person’s family, rather than individual poverty — would come into play and negatively affect people of color disproportionately.

Research has also shown that black patients receive worse medical care than white patients (this article focuses on diabetes care in particular; I am fairly sure I have seen research that demonstrated similar disparities in hospital care).

This is white privilege: even when you are aging and/or disabled, with all the trouble society gives you, your racial background is still giving you a hand up over those who do not share your privilege.

Thanks to Anna for the link.

(Cross-posted at Three Rivers Fog)

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9 comments for “In nursing homes, black residents receiving worse care than white residents

  1. July 10, 2009 at 8:27 pm


    Sadly, this doesn’t surprise me.

    So many are sent to nursing homes and forgotten about. Which makes such a report even more disgusting.

    It just never ends.

    That said, such reports only make me more fascinated by the continued strength and resilience of Black Americans.

    I wonder why Rev. Al and Rev. Jesse haven’t stepped up to speak on this issue?

  2. July 11, 2009 at 6:33 am

    ‘more of a mission than a business’? nursing homes exist to maximize profit. it’s in their best interest to spend as little as possible on staff and services. like any business they charge what the market will bear and calculate how to give the least for the most money.
    race is part of the equation–it marks a group of people who are less likely to have the social power and connections that would give them leverage in a dispute. race is also a marker for low income. and remember that the children of the 90 year old in the nursing home are likely to be in their late 60’s and early 70’s and may have health and financial problems of their own. if they are younger they may be trying to help their own children get started in life.
    as long as there is financial inequity and as long as health care is profit-driven, the least advantaged people will get the worst care from cradle to grave.

    • July 11, 2009 at 9:03 am


      There are both for-profit homes and non-profit homes. The article looked at those:

      For-profit homes have increased their presence in black neighborhoods. In Chicago, all but one, or 97 percent, of the 30 majority-Black homes are for-profit. Schwab Rehabilitation Hospital in North Lawndale was the exception. By contrast, 29 percent of the 45 majority-white homes were nonprofit.

      Nationally and locally, for-profit homes have received lower ratings than nonprofit facilities. In Chicago, 24 of the city’s 75 for-profit homes received the lowest rating from Nursing Home Compare, while none of the 17 nonprofit homes earned the same mark. By contrast, six of the nonprofit facilities received the top rating, and just eight of the for-profit homes got the same marks.


      The article also states that the disparities still exist when you consider staffing, Medicaid funding and the class status of the residents. No matter what factor you measured with, blacks still fared worse than whites.

      I also think it isn’t particularly productive to completely dismiss racism as a factor. Yes, examine every factor that exists. But the existence of other factors does not mean that racism cannot be a factor. Racism is not a diagnosis of exclusion. And if we avoid examining our hidden biases — because it makes us uncomfortable, because we just don’t feel like that could be why, or any other reason — then we are avoiding the whole picture, deliberately stunting our ability to solve these problems, deliberately avoiding engaging with something that can be causing serious harm. And I think the article made it quite clear that something is.

  3. tam
    July 11, 2009 at 8:34 am

    This is a very telling article. However, to just call it racism and an effect of privilege is too simpe. To understand the quality of care in nursing homes you have to look at various factor in the system – staffing, funding – particularly Medicaid funding. And yes, the blatant greed of some nursing nursing home owners, be they black or white.

  4. Diana
    July 11, 2009 at 1:27 pm

    Was there anything about the racial make-up of the staff at these homes?

  5. July 11, 2009 at 2:42 pm

    They are probably staffed by overworked, underpaid people of color and people who are immigrants. In a bad nursing home morale is low, turnover is high, the best burn out and the worst stay. Staff teaching is neglected and there is no chance for advancement. The patient/staff ratio is terrible and the administration is not involved in the day to day concerns of the patients and families.

  6. tam
    July 11, 2009 at 6:13 pm

    I know that racism is not aomething to be ignored. I would rather focus on the things that can be changed regarding the staffing and cultures of poor quality homes. As Nancy pointed out staffing and morale are huge determinants of whether or not there is quality care in a home.

  7. Blackbird
    July 18, 2009 at 1:06 pm

    Speaking as an EMT who works in Chicago for a private ambulance service, and spends most of her day transporting the residents of the nursing homes discussed, in my opinion the issue of quality of care in nursing homes is more of a systemic problem, though I agree with the impression the statistics of this article gives. It has been my observation that even within a group of homes owned and operated by the same people, in other words a chain of nursing homes, the quality of care varies greatly based on the color of the people living there, but the source of that lack of care seems to be financial, not solely race-based.

    In Chicago nursing homes there is a clear hierarchy. On top are the religiously run nursing homes and the ones (generally in the wealthier suburbs) who cater to people who have very good private insurance and who don’t accept medicaid payments. Then are the homes in the city who accept mixtures of medicare and medicaid paying residents and are usually mixed in race but tend to predominate as white. Lastly, and worst, are the homes that have residents who depend on medicaid for their care. Those homes are also usually mixed race, but tend towards predominating as black.

    Now, to me, (and I get a look at the insurance and benefits of every patient I transport for my own paperwork) it seems that the more patients on medicaid versus medicare and private insurance a home has, the poorer the quality of care is, regardless of race. The correlate to that is that there seem to be more black people who are depending on medicaid for their care, so those homes that run off of medicaid tend to be black, and thus continue in a vicious circle.

    However, no matter whether the home is largely black or white, if it is a place running on a small budget, you get the same lack of care wherever you are. Patients are not bathed or clothed as they should be. There is little to no effort at helping them keep the independence to simply get out of bed alone, or feed themselves, much less anything else. Instead of having neatly made beds patients are sometimes found laying on bare mattresses without even a single sheet. The homes are often poorly cooled in summer (and it gets hot here, believe me), and the places stink of urine and feces. Patients with mental illnesses have poor supervision and frequently get lost or have access to street drugs (taking a 73 year old with a heroin overdose out of a nursing home was a novel experience, let me tell you).

    The nurses are very different depending on how much they get paid as well. Many of the nurses in poorer homes are immigrants, and thus have had training that is not up to US standards, and sometimes they can’t even speak enough english to make the patient’s situation clear to me or other emergency staff. If you are a Certified Nursing Assistant getting paid $8.50 an hour, how much devotion are you going to feel for your job and your patients? Not very much, I can assure you. The doctors supposedly in charge of these patients care are rarely seen and prefer to send patients out of a home to an emergency room for even the smallest complaint, which is where my job and presence often come in. These doctors get kickbacks for bringing business to the hospitals, and patients are sent out to the ER for things like a cold, or a boil that could easily be taken care of in-house if the doctor was around regularly and had competent nurses.

    As I said above, it seems to me to be a problem with money, but because the black nursing homes also tend to have more problems with money, they also have a lower average quality of care. It is tragic, and the system is inherently flawed.

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