Distribution of African Americans in Residential Care/Assisted Living and Nursing Homes: More Evidence of Racial Disparity?

Department of Natural and Physical Sciences, Environmental Science Program, Shaw University, Raleigh, NC, USA.
American Journal of Public Health (Impact Factor: 4.55). 09/2002; 92(8):1272-7. DOI: 10.2105/AJPH.92.8.1272
Source: PubMed


In this study, we examined racial separation in long-term care.
We used a survey of a stratified sample of 181 residential care/assisted living (RC/AL) facilities and 39 nursing homes in 4 states.
Most African Americans resided in nursing homes and smaller RC/AL facilities and tended to be concentrated in a few predominantly African American facilities, whereas the vast majority of Whites resided in predominantly White facilities. Facilities housing African Americans tended to be located in rural, nonpoor, African American communities, to admit individuals with mental retardation and difficulty in ambulating, and to have lower ratings of cleanliness/maintenance and lighting.
These racial disparities may result from economic factors, exclusionary practices, or resident choice. Whether separation relates to inequities in care is undetermined.

Download full-text


Available from: Daniel L Howard,
  • Source
    • "Health disparities also occur whenever caregivers and victims of abuse perceive health care providers as being too detached from community networks , particularly because having a strong sense of community is especially important to African Americans (Griffin, 1999). African Americans also may fear being judged due to cultural values and traditions that divert from the majority culture (e.g., multigenerational parenting) (Hall, 1999; Howard et al., 2002; Griffin, 1999). In fact, it has been documented that African Americans are at increased risk of being misdiagnosed when receiving mental health services due to cultural differences with the majority culture (Mills & Edwards, 2002). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite the rapid growth of the elderly African American population in the U.S., elder abuse and neglect in African American families continue to be underdeveloped areas of study. This article presents an ecological and culturally informed framework for the study of elder abuse in African American populations. The model was developed based on Bronfenbrenner's Human Ecological Theory. The model identifies risk factors associated with different systems that have an influence on the lives of African American families. Cultural protective factors also are identified in the model. The model is intended to provide an understanding of elder abuse and neglect in African American families by considering the influence of contextual factors such as the legacy of slavery, social exclusion, and structural segregation and racism. Specific suggestions for practice are proposed according to cultural strengths of African American communities as well as the ecological premises of the model.
    Journal of Elder Abuse & Neglect 01/2011; 23(1):75-88. DOI:10.1080/08946566.2011.534709
  • Source
    • "Findings from previous research indicate that Black, Hispanic, and some Asian American populations have higher rates of chronic disease[8], are less likely to utilize health care, and experience more barriers of access to healthcare system than Whites[9]. Although Black, Hispanic and Asian Americans have lower nursing home services utilization[10,11], the ethnic users consume home care resources more intensively than White users[12,13]. A United States based study of patients in a nursing home demonstrates that elderly Asian Americans patients rely more heavily on family members to provide medical decision-making than other populations[10]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Heart failure (HF) is a major cause of hospitalization and death in the aging population around the world. Home care utilization is associated with improved survival for the patients with HF, and varies by ethno-culture. The purpose of this study was to investigate the difference in hospital readmission rate and mortality between Asian and other Canadian HF patients. HF patients were identified using hospital discharge abstracts from March 31, 2000 to April 1, 2006 in Calgary Health Region. Readmission and one-year mortality for HF were determined by linking hospital discharge and vital statistics data. Stratified by home care services use, readmission and mortality rates were compared between the Asians and other Canadians while controlling for age, sex, comorbidities, and household income. Of 26,171 HF patients discharged from hospital, 56.6% of Asians and 58.0% of other Canadians used home care services [adjusted odds ratio (OR) for Asian: 0.84, 95% confidence interval (CI): 0.74-0.89]. The hospital readmission rate was similar between Asians and other Canadians regardless of home care services use. Mortality was similar between those who used home care services (adjusted OR for Asian: 0.96, 95% CI: 0.81-1.13). For patients who did not use home care services, Asians had significantly lower mortality than other Canadians (adjusted OR for Asian: 0.76, 95% CI: 0.60-0.86). Mortality was similar between Asian and other Canadian patients when home care services were utilized. However, among those without home care, Asian patients had a significantly lower mortality than other Canadian patients.
    BMC Cardiovascular Disorders 03/2010; 10:12. DOI:10.1186/1471-2261-10-12 · 1.88 Impact Factor
  • Source
    • "Nursing homes are more segregated than other health care sectors and, often, more segregated than the neighborhoods in which they are located (Smith 1990). In addition, while blacks are less likely than whites to use assisted living overall, the same segregation patterns tend to exist in assisted living as in nursing homes (Howard, Sloane et al. 2002). Although segregation of nursing homes due to people's preference to stay in neighborhoods where they and their families live may not in itself result in disparities according to the IOM definition, the racial and socioeconomic composition of nursing home residents is highly correlated with quality. "

Show more