title: Contextual determinants of US nursing home racial/ethnic diversity.
abstract: We hypothesized that for-profit/chain affiliated nursing homes, those in states with higher Medicaid reimbursement, and those in more competitive markets would have greater resident racial/ethnic diversity than nursing homes not meeting these criteria. Using 2004 Online Survey, Certification and Reporting data, Minimum Data Set, Lewis Mumford Center for Comparative Urban and Regional Research data, and the Area Resource File, we included U.S. Medicare/Medicaid certified nursing homes (N = 8950) located in 310 Metropolitan Statistical Areas. The dependent variable quantified facility-level multiracial diversity. Ordinary least squares regression showed support for the hypothesized relationships: for-profit/chain affiliated nursing homes were more diverse than nursing homes in all other ownership/chain member categories, while higher Medicaid per-diem rates, greater residential diversity, and stronger market competition were also positively associated with nursing home racial/ethnic composition. Results suggest there is room for policy changes to achieve equitable access to all levels of nursing home services for minority elders.
authors.affiliation: Management Department, The University of Alabama, Box 870225, Tuscaloosa, AL 35487, USA; Center for Mental Health and Aging, The University of Alabama, Box 870315, Tuscaloosa, AL 35487, USA. Electronic address: jdavis@cba.ua.edu.
authors.forename: Jullet A
authors.initials: JA
authors.lastname: Davis
authors.affiliation: Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 1530 Third Avenue South, Birmingham, AL 35294, USA. Electronic address: rweech@uab.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Weech-Maldonado
authors.affiliation: Department of Epidemiology and Community Health, Virginia Commonwealth University, School of Medicine, P.O. Box 980212, Richmond, VA 23298-0212, USA. Electronic address: kllapane@vcu.edu.
authors.forename: Kate L
authors.initials: KL
authors.lastname: Lapane
authors.affiliation: Division of Health Promotion and Disease Prevention; Center for Medicare & Medicaid Innovation, USA. Electronic address: alexandre.laberge@cms.hhs.gov.
authors.forename: Alex
authors.initials: A
authors.lastname: Laberge
mesh_terms: D000368:Aged; D018864:Cultural Diversity; D004465:Economic Competition / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D006269:Health Facilities, Proprietary / Q000458:organization & administration; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D009735:Nursing Homes / Q000191:economics* / Q000458:organization & administration*; D010067:Ownership / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data*; D014481:United States
keywords: Diversity; Minorities; Nursing homes; Race/Ethnicity; Segregation; United States