Public Health

Nursing properties with extra minority residents had extra Covid deaths: research

Derede McAlpin is holding a photo of her mother, Sara McAlpin, 92, who was diagnosed with Covid-19 in Rockville, MD.

Katherine Frey | The Washington Post | Getty Images

Nursing homes with more minority residents reported more than three times as many deaths in Covid as those with more white residents, a large study published on Wednesday found.

The University of Chicago researchers examined 13,312 U.S. nursing homes and analyzed Covid data reported to the Centers for Disease Control and Prevention from May through December. They found that nursing homes where more than 40% of their residents were black or Spanish reported 3.3 times as many deaths and cases in Covid as nursing homes with more white residents.

Nursing homes and other long-term care facilities are hardest hit by the pandemic. Less than 1% of Americans live in such facilities, according to the CDC, but they have caused nearly 40% of all deaths in the United States, according to the COVID Tracking Project.

It is well documented that the pandemic has disproportionately affected the ethnic and racial minorities in the United States. President Joe Biden and his administration have vowed to ensure justice throughout the vaccine distribution process and to prioritize color communities disproportionately affected by the pandemic.

The new study, published on JAMA Network Open, shows how these differences affect nursing homes and has policy implications for vaccine distribution.

The differences were due to some historical factors, the researchers said. For example, minority residents in nursing homes are more likely to live in large facilities that are for-profit, rely more on Medicaid, and “have shortcomings in care,” the researchers said. They added that “Nursing homes in the US are very segregated”

An Empress EMS paramedic loads a suspected COVID-19 patient into an ambulance on April 7, 2020 in Yonkers, New York.

John Moore | Getty Images

“Before the COVID-19 pandemic began, racial differences in the quality of home care were known to be common,” the authors wrote. “Compared to whites, blacks are more likely to be admitted to the lowest quality nursing homes that have lower nursing staffing rates, more serious regulatory deficiencies, and a higher likelihood of being excluded from the Medicaid program.”

The researchers, health economists Rebecca Gorges and Tamara Konetzka, added that the pandemic is a “perfect storm” for residents of nursing homes.

“With minority communities having the highest COVID-19 infection rates and nursing homes in these communities generally being of lower quality, non-white nursing home residents are in the eye of this perfect storm,” they wrote.

The study finds that the death toll of Covid in U.S. nursing homes is likely to decline soon with the introduction of the vaccine. The CDC recommends that states give the vaccine to residents and long-term care workers as a priority before moving on to other segments of the population.

The Federal Pharmacy Partnership for Long-Term Care program allowed states to tap into pharmacies like CVS and Walgreens to help distribute the vaccine. As part of that program, more than 5 million doses have been given to residents and long-term care workers since Tuesday, according to the CDC.

“As vaccination progresses, it will be important for policy makers to consider existing inequalities to ensure that the vaccine distribution process includes a special effort to reach color communities,” the researchers wrote in the study.

They noted some limitations to their study. Institution-level data is publicly available through the CDC, but comprehensive individual-level data is not available. Such data “is needed to understand whether there are intra-facility differences in addition to differences between facilities,” they said.

They added that as of May, the data they analyzed were reported by nursing homes themselves, omitting many of the cases and deaths that had previously occurred. And they said the federal data “didn’t allow any racial classifications other than white, black, and Hispanic.” More detailed data would have enabled further analysis of the data across different racial groups.

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