New evidence of racial differences in access and their effects on the use of nursing homes among older adults.
BACKGROUND
Historical disparities in rates of nursing home placement between blacks and whites have been well documented, and are thought to result from more extensive and supportive social networks, cultural aversion, and poorer geographic access among African Americans. A few recent studies, however, suggest that these racial disparities may no longer exist. We used comprehensive data to assess whether racial differences in nursing home placement remain, and if so, to identify the reasons for them.


METHODS
Data on 6242 black and white self-respondents to the Survey of Assets and Health Dynamics Among the Oldest Old cohort who were 70 years old or older at baseline (1993) were used. Placement status was ascertained at each biennial follow-up through 2004, and discrete-time hazards models were estimated.


RESULTS
After adjusting for baseline covariates, it was found that blacks were 26% (lambda = 0.74, P < 0.001) less likely to use a nursing home over an 11-year period than whites. Moreover, the supply of skilled nursing beds was more salient for nursing home placement for blacks than whites, as was the increasing supply of assisted living beds.


CONCLUSIONS
The racial gap in nursing home placement remains, despite the increased supply of nursing home beds and the emergence of assisted living facilities as the preferred alternative. As the supply of skilled nursing beds increases, in part due to whites choosing assisted living facilities, the racial gap in the risks of nursing home placement may be lessening. Blacks, however, remain less likely to be placed in a nursing home than whites.
Akamigbo
Adaeze B
AB
Department of Health Management and Policy, The VA Iowa City Health Care System, Iowa City, IA 52241, USA. adaeze-akamigbo@uiowa.edu
Wolinsky
Fredric D
FD
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D040561:Assisted Living Facilities / Q000706:statistics & numerical data* / Q000639:trends; D001294:Attitude to Health; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data / Q000639:trends*; D006304:Health Status; D006707:Homes for the Aged / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data* / Q000639:trends; D012959:Socioeconomic Factors; D013997:Time Factors; D044465:White People / Q000706:statistics & numerical data*