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Relationship between State Medicaid Policies, Nursing Home Racial Composition, and the Risk of Hospitalization for Black and White Residents

Authors

  • Andrea Gruneir,

    1. Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, Toronto, ON M6A 2E1 (Canada)
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    • Address correspondence to Andrea Gruneir, Ph.D., Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, Toronto, ON M6A 2E1 (Canada). Susan C. Miller, Ph.D., and Vincent Mor, Ph.D., are with the Center for Gerontology and Health Care Research and the Department of Community Health, Brown University, Providence, RI. Zhanlian Feng, Ph.D., and Orna Intrator, Ph.D., are with the Center for Gerontology and Health Care Research, Brown University, Providence, RI.

  • Susan C. Miller,

    1. Center for Gerontology and Health Care Research and the Department of Community Health, Brown University, Providence, RI
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  • Zhanlian Feng,

    1. Center for Gerontology and Health Care Research, Brown University, Providence, RI.
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  • Orna Intrator,

    1. Center for Gerontology and Health Care Research, Brown University, Providence, RI.
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  • Vincent Mor

    1. Center for Gerontology and Health Care Research and the Department of Community Health, Brown University, Providence, RI
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Abstract

Objective. To examine racial differences in the risk of hospitalization for nursing home (NH) residents.

Data Sources. National NH Minimum Data Set, Medicare claims, and Online Survey Certification and Reporting data from 2000 were merged with independently collected Medicaid policy data.

Study Design. One hundred and fifty day follow-up of 516,082 long-stay residents.

Principle Findings. 18.5 percent of white and 24.1 percent of black residents were hospitalized. Residents in NHs with high concentrations of blacks had 20 percent higher odds (95 percent confidence interval [CI]=1.15–1.25) of hospitalization than residents in NHs with no blacks. Ten-dollar increments in Medicaid rates reduced the odds of hospitalization by 4 percent (95 percent CI=0.93–1.00) for white residents and 22 percent (95 percent CI=0.69–0.87) for black residents.

Conclusions. Our findings illustrate the effect of contextual forces on racial disparities in NH care.

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