Nursing home closures in the United States tend to be concentrated in areas that are less affluent, more black or more Hispanic, a study in a leading medical journal has found.
Between 1999 and 2008, there was a net loss of more than 5% of nursing home beds, with a significantly higher risk of closure in ZIP codes with a higher proportion of blacks or Hispanics or a higher poverty rate, according to the report published online Tuesday by Archives of Internal Medicine.
During the years studied, 1,776 freestanding nursing homes closed, representing 11% of the total, compared with 1,126 closures of hospital-based facilities: nearly 50%, wrote the authors, led by Zhanlian Feng of Brown University.
Nursing homes in the nation's poorest ZIP codes were twice as likely to close as those in the most affluent areas. In the four ZIP codes with the highest percentage of blacks, nursing homes were 38 percent more likely to close than those in the four ZIP codes with the lowest concentration of blacks. The numbers for Hispanic populations were nearly identical.
"In the broader context of structural and socioeconomic disparities and persistent racial residential segregation, the clustering of nursing home closures in poor and minority-concentrated urban neighborhoods is troubling," the authors wrote.
"This phenomenon, arguably, resembles similar dynamics of inequalities in public schools, housing, environmental decline and other sectors."
The authors and an accompanying editorial express concern that as the population ages, certain groups' access to quality elder care will be limited.
"The one thing that is worse than having to put your mother in a nursing home is having to put your mother in a nursing home and having no high-quality facilities to choose from," Dr. Mitchell H. Katz of the San Francisco, California, Department of Health writes in the editorial.
The economic and ethnic disparities could force elders to be placed in facilities far from their families and communities, Katz wrote.
"Worse yet, because they are from low-income families, their friends and relatives may not be able to afford frequent trips to visit them," he wrote.
Katz argues that Medicare should start helping pay for assisted living and other alternatives to nursing home care, that doctors should demand "high-quality nursing homes in the communities where people have lived" and that doctors should "be more present" in nursing homes to help raise the quality of care.
The study will be published in the May 9 print issue of Archives of Internal Medicine, according to Science Daily.