A new study led by researchers at Brown University found that between 1999 and 2008, nursing home closures in the United States were concentrated disproportionately in poor, urban, and predominantly minority neighborhoods.
Overall, the United States lost 5%, or 96,902, of its total nursing home beds during the decade, as patients with means sought assisted living or other forms of home and community-based care instead, researchers reported. But nonhospital nursing homes were twice as likely to close in the poorest ZIP codes of the country than in the richest ones, according to the study recently published online by the Archives of Internal Medicine.
Nursing homes were also 1.38 times more likely to close in the most predominantly black ZIP codes than in ZIP codes with the lowest representation of blacks, and 1.37 times as likely to close in the most predominantly Hispanic ZIP codes than in the least Hispanic areas.
The net result is that poor and urban people, particularly minorities, will have fewer choices for the long-term care they need, said Vince Mor, the Florence Pirce Grant University Professor of Community Health at Brown and a senior author of the paper.
“This is an issue that is not going to go away, precisely because of the aging of the population and the increasing bifurcation of society into rich and poor,” he said.
The researchers also found that many people in poor urban neighborhoods will have to travel significantly farther to a nursing home. In ZIP codes where at least one nursing home closed during the decade, the shortest distance to another home increased to 3.81 miles from 2.73 miles.
“The further the patient is from their neighborhood, the more difficult it is for their family members and their neighbors to come visit them,” Mor said.
If finding new money for nursing homes is not the entire answer for preserving access for the poor to long-term care, another option is to shift more money toward alternatives like assisted living, home-based care, and community-based care, researchers said. The new healthcare law and a system of waivers within Medicaid encourage states to do just that, but they are not targeted specifically to helping the urban poor or minorities, and they are optional programs. By contrast, reimbursements for nursing home care are legally required.
“Given the current budget environment, it is really uncertain how sustainable these alternatives will be,” researchers said.
The study was funded in part by the National Institute on Aging.