In April, a special article appeared in JAMDA (Journal of the American Medical Directors Association) titled, “Addressing Systemic Racism in Nursing Homes:  A time for Action”.  While this article is copyrighted, it may be worth purchasing if you are not already a subscriber.  Table 1 outlines the Structural/Institutional, Cultural, and Interpersonal manifestations of racism in our facilities.  Figure 2 outlines how these factors have operated at a policy and operational level.  

I’m grateful to the Center for Medicare Advocacy who interviewed one of the above study authors and wrote a succinct free article titled, “Experts Spotlight Systemic Racism in U.S. Nursing Homes and Call for Action.  During the past pandemic year our long-term care facilities have born the burden of COVID-19 deaths with ~ 1/3 of the deaths nationally while only representing 5% of the population.  In addition facilities with a higher proportion of black residents had 45-300% greater probability of a COVID outbreak.     

The authors recommend policy and practice changes that encourage wealth building in our segregated neighborhoods, increase Medicaid payments to nursing homes, increase direct-care worker wages, and collection of race-related health outcomes data for our residents and staff.  

We need to be accountable for this request for greater funding.  The collection of this outcome data needs to be systematized.  Our facilities will need to be held to a higher reporting standard for their financial performance.  In recent years the ownership of many of our facilities has changed to investor partnerships that have connected support businesses.  Each facility reports their expenses publicly, but the degree of investor profit from their connected ancillary businesses, is seldom publicly available.  This information is crucial for ensuring that any added public funding goes for increasing direct-care worker wages and improving access for people of all races to high quality nursing home care.  This will help us meet state-mandated CNA staffing metrics and reduce staff turn-over.  Stabilizing our staffing should greatly improve our care and quality metrics.

This pandemic has exposed Systemic Racism as a significant problem in long-term care.  At CALTCM, we believe greater financial transparency will support greater public funding for timely and incremental corrective actions.  This is why we are one of the sponsors for SB 650.  Will you support this legislation with us? 

I have offered my opinion about connecting this legislation to our efforts to improve healthcare disparities and our quality improvement efforts.  Let us know what you think.  

Resources

CALTCM Advocacy Page: https://www.caltcm.org/advocacy 

https://medicareadvocacy.org/systemic-racism-in-nursing-homes/

Link to JAMDA article:  https://pubmed.ncbi.nlm.nih.gov/33775548/