Racial Sorting Among Nursing Home Residents, 2011-2017

We contribute to the literature measuring segregation in the health care setting by constructing dissimilarity indices (DI) for nursing homes and counties to examine relationships with income inequality, reliance on Medicaid, urbanicity, and quality.

Abstract:

Nursing homes are thought to be among the most racially segregated of health care institutions \citep{rahman_racial_2015}, yet no research since 2005 documents the changing nature of patient sorting in nursing homes. This research contributes to the literature by calculating dissimilarity indices for nursing homes for 2011-2017. The dissimilarity index (DI) is widely used in residential segregation studies, and, in our context, indicates the proportion of patients in a county who must move nursing homes to achieve an equal racial/ethnic distribution representative of that county. We use administrative data covering all certified nursing homes in the U.S. and patients in these homes. We find that nursing home DI is highest for the Black/white (29.2) comparison, then Hispanic/white (28.0), followed by BIPOC/white (27.4). Hispanic/white nursing home DI exceeds general population DI, but the inverse is true for BIPOC/white and Black/white. Furthermore, nursing home DI is higher for older patients and patients with no ADRD/SMI and patients with ADRD only. Overtime, nursing home and general population DIs decreased for all racial/ethnic groups, however, nursing home DI by patient age, marital status, and ADRD/SMI status increased overtime for all racial/ethnic groups.

Recommended citation: Bowblis, John, Megdalynn Fisher, and Kosali Simon. "Racial Sorting Among Nursing Home Residents" work in progress.