COVID-19 deaths in long-term care facilities account for one-third of the nation’s death toll – even though only five percent of the cases have occurred in these facilities. “People in nursing homes”, as Robert Espinoza, Vice President of Policy at PHI, states, “were at ‘ground zero’ of the pandemic.”
In addition to hitting long-term care facilities the hardest, COVID-19 also highlighted racial and ethnic disparities within these care settings. The Centers for Disease Control and Prevention (CDC) reports that evidence suggests some racial and ethnic minority groups were disproportionately affected by COVID-19, and that long-standing systemic health and social inequities have put many people from these groups at increased risk of getting sick and dying from COVID.
Mr. Espinoza is one of several co-authors of a new article titled “Addressing Systemic Racism in Nursing Homes: A Time for Action”, published in the Journal of Post-Acute and Long-Term Care Medicine (JAMDA). Espinoza and his co-authors assert that these disparities are a result of longstanding “structural, interpersonal and cultural racism” in the United States. They found that the proportion of Black residents in a nursing home was correlated with an increased probability of a COVID-19 outbreak anywhere from 45% to 300%. The authors examine two characteristics of nursing home environments that contribute to these disturbing statistics – a “racially segregated care system”, and a “racially stratified workforce”.
In the care system setting, the authors explore why Black Americans are disproportionately more likely to rely on nursing home care. In speaking with the Center for Medicare Advocacy, Mr. Espinoza explains,
“we really don’t have a strong home and community-based services system, and that forces many people of color – who don’t have the income to live in assisted living or hire their own caregiver out-of-pocket – to go into nursing homes. Black and Latinx people of color in particular are more likely to end up in nursing homes.”
The article also highlights that Black individuals are also cared for in facilities that are often for-profit, serve a primarily Medicaid population, have lower levels of nurse staff, and have lower resident outcomes.
The 1.3-1.7 million direct care workers in long-term care settings also suffer from the impacts of systemic racism. The workforce is largely comprised of low-paid, ethnic minorities who are primarily female, and who are largely relegated to the “bottom of the health care occupational ladder”. Direct care workers are paid so little, in fact, that almost 20% live in poverty and more than half rely on some form of public assistance. Furthermore, the authors point out that long-term care settings are “essentially institutions where low-paid people of color care for a primarily White clientele under the supervision of primarily White managers.”
The authors recommend policy and practice recommendations to address the impacts of systemic racism in the long-term care environment, which range from investing in segregated neighborhoods to build wealth, examining public financing of nursing homes to increase Medicaid payments, and increasing direct-care worker wages. For Mr. Espinoza, an important key is racial disparity data. “It starts with collecting data on outcomes within the workforce,” he argues. “And then it means targeted strategies to support people of color and women and immigrant workers to make sure that they can rise up that career ladder.”
 KFF, “State COVID-19 Data and Policy Actions” (Apr. 6, 2021). Retrieved April 06, 2021, from https://www.kff.org/coronavirus-covid-19/issue-brief/state-covid-19-data-and-policy-actions/
 CDC, “Health equity considerations and racial and ethnic minority groups” (Feb. 12, 2021). Retrieved April 06, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html
 Sloane, P. D., Yearby, R., Konetzka, R. T., Li, Y., Espinoza, R., & Zimmerman, S. (2021). Addressing systemic racism in nursing homes: A time for action. Journal of the American Medical Directors Association, 22(4), 886-892. doi:10.1016/j.jamda.2021.02.023