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.

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.

tam,

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.

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?