Megdalynn Fisher, MPA

Megdalynn Fisher, MPA

she/her

PhD Candidate

Racial, Demographic and Health Sorting Among Nursing Home Residents

This project leverages panel data from 2011–2017 to assess racial segregation in nursing homes versus local communities using the Dissimilarity Index, revealing persistent disparities across racial, demographic, and health groups that inform targeted policy interventions in long-term care.

Abstract:

Despite major policy and societal changes over two decades, trends in the demographic and health sorting of nursing home residents remain under explored. We examine racial sorting in nursing homes relative to local communities, including novel measures of Black, Indigenous, and people of color (BIPOC)/white and Hispanic/white comparisons alongside the established Black/white measure. Using panel data from 2011–2017, we calculate the dissimilarity index (DI) overall and within key subgroups (age, marital status, and cognitive/mental health status) to assess changes in segregation over time and across resident characteristics.

Sorting is higher in nursing homes than in the community for Hispanic/white comparisons, whereas for Black/white and BIPOC/white comparisons, community sorting exceeds that in nursing homes. Within nursing homes, sorting is highest for Black/white comparisons, higher among older than younger residents, and lowest for those with serious mental illness — possibly reflecting payment source heterogeneity among older residents. Over the study period, overall racial sorting decreased, yet increased within certain demographic and health subgroups. These findings underscore the need to understand drivers and consequences of multidimensional sorting in long-term care.

Key Words:

Dissimilarity Index (DI), Racial/Ethnic Segregation, Healthcare Disparities, Nursing Home Care, Long-Term Care, Structural Racism, Aging, Minority Health

Key Points:

  • Overall Trends: Both nursing home and community segregation—as measured by the Dissimilarity Index (DI)—have declined over time across all racial/ethnic groups, suggesting progress in reducing overall disparities.
  • Persistent Racial Disparities: Segregation remains highest in Black/white comparisons (DI = 29.2), followed by Hispanic/white (DI = 28.0) and then BIPOC/white (DI = 27.4), indicating the need for targeted interventions to address enduring racial inequities.
  • Setting-Specific Dynamics: The Hispanic/white DI in nursing homes exceeds that in the broader community, whereas the opposite is true for BIPOC/white and Black/white comparisons, underscoring distinct dynamics in long-term care markets.
  • Influence of Resident Characteristics: Higher levels of segregation are found among older residents, those without ADRD/SMI, and residents with ADRD only—pointing to the significant role of demographic and health factors in shaping resident placement.
  • Rising Intra-Group Segregation: Despite overall declines, segregation by age, marital status, and ADRD/SMI status has increased over time across all racial/ethnic groups, signaling that future policies must address not only racial disparities but also intersecting demographic and health-related inequities in long-term care.

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