title: Nurse Staffing Hours At Nursing Homes With High Concentrations Of Minority Residents, 2001-11.
abstract: Recent increases in state Medicaid payments to nursing homes have the potential to reduce disparities in nurse staffing between facilities with high and low concentrations of racial/ethnic minority residents. Analyses of nursing home and state policy survey data for the period 2001-11 suggest that registered nurse and licensed practical nurse staffing levels increased slightly during this period, regardless of racial/ethnic minority resident concentration. Adjusted disparities in registered nurse hours per resident day between nursing homes with high and low concentrations of minority residents persisted, although they were reduced. Certified nursing assistant hours per patient day increased in nursing homes with low concentrations of minorities but decreased in homes with high concentrations, creating a new disparity. Overall, increases in state Medicaid payment rates to nursing homes were associated with improvements in staffing and reduced staffing disparities across facilities, but the adoption of case-mix payments had the opposite effect. Further reforms in health care delivery and payment are needed to address persistent disparities in care between nursing homes serving higher proportions of minority residents and those serving lower proportions, and to prevent unintended exacerbations of such disparities.
authors.affiliation: Yue Li (yue_li@urmc.rochester.edu) is an associate professor in the Department of Public Health Sciences at the University of Rochester, in New York.
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.affiliation: Charlene Harrington is a professor of nursing at the University of California, San Francisco.
authors.forename: Charlene
authors.initials: C
authors.lastname: Harrington
authors.affiliation: Dana B. Mukamel is a professor in the Department of Medicine, University of California, Irvine.
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
authors.affiliation: Xi Cen is a PhD candidate in the Department of Public Health Sciences at the University of Rochester.
authors.forename: Xi
authors.initials: X
authors.lastname: Cen
authors.affiliation: Xueya Cai is a research associate professor in the Department of Biostatistics and Computational Biology at the University of Rochester.
authors.forename: Xueya
authors.initials: X
authors.lastname: Cai
authors.affiliation: Helena Temkin-Greener is a professor in the Department of Public Health Sciences at the University of Rochester.
authors.forename: Helena
authors.initials: H
authors.lastname: Temkin-Greener
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008913:Minority Groups; D009735:Nursing Homes; D009740:Nursing Staff / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000639:trends; D014481:United States
keywords: Disparities; Long-Term Care