The COVID-19 pandemic highlighted deeply rooted racial and ethnic health disparities nationwide[1] – particularly within the walls of U.S. nursing homes. Nursing homes with a larger proportion of Black and Hispanic residents reported more deaths and more severe COVID outbreaks.[2] A study recently published in the Journal of the American Geriatrics Society, sheds light on additional potential ramifications of structural and systemic racial and ethnic inequalities in nursing homes.
The study examined whether the Centers for Medicare & Medicaid Services’ (CMS) National Partnership to Improve Dementia Care in Nursing Homes (National Partnership) – an example of a “colorblind” policy – produced any unintended consequences for long-stay nursing home residents regarding schizophrenia. By examining Minimum Data Set 3.0 between 2011 and 2015, researchers concluded that Black nursing home residents with Alzheimer’s disease and related dementias (ADRD) were more likely to be diagnosed with schizophrenia compared to nonblack residents. In fact, schizophrenia rates increased during the period of the study only for Black residents with ADRD. [3]
The National Partnership, according to CMS, is focused on improving quality of care for individuals with dementia living in nursing homes.[4] Researchers note the partnership was also a federal response to potentially inappropriate use of antipsychotics in nursing homes. Historically (and still today), antipsychotics have been misused by nursing homes to treat the behavioral and psychological symptoms of dementia.
Researchers underscored that “colorblind racism” is a new form of racism that can be portrayed through the creation of policies that do not account for the existence of structural systems that have disadvantaged vulnerable populations, such as Black nursing home residents. Such policies could further exacerbate existing health inequalities. In a conversation with the Center for Medicare Advocacy, the article’s lead author, Dr. Shekinah Fashaw-Walters, suggested that an alternative approach to “colorblind” policies, would be “color-conscious” policies – policies that recognize structural inequities and account for their influences on vulnerable populations and health. Being “color-conscious”, Dr. Fashaw-Walters holds, would support the inclusive improvement of quality of care for all nursing home residents.
October 21, 2022 – C. St. John
[1] CDC. COVID-19 Racial and Ethnic Disparities. (Dec. 10, 2020). Available at: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html
[2] Neuman, T. & Chidambaram, P. Racial and Ethnic Disparities in COVID-19 Cases and Deaths in Nursing Homes. KFF. (Oct. 27, 2020). Available at: https://www.kff.org/coronavirus-covid-19/issue-brief/racial-and-ethnic-disparities-in-covid-19-cases-and-deaths-in-nursing-homes/
[3] Fashaw‐Walters, S. A., McCreedy, E., Bynum, J. P., Thomas, K. S., & Shireman, T. I. “Disproportionate increases in schizophrenia diagnoses among black nursing home residents with ADRD.” Journal of the American Geriatrics Society. (Sept. 30, 2021). Available at: https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.17464
[4] CMS. National Partnership to Improve Dementia Care in Nursing Homes. (n.d.). Available at: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/National-Partnership-to-Improve-Dementia-Care-in-Nursing-Homes