In August 2021, Community Legal Services of Philadelphia, Center for Advocacy for the Rights & Interests of the Elderly (CARIE), and a coalition of advocates for the rights of nursing home residents released Separate and Unconscionable: A Report on Racial and Ethnic Disparities in Pennsylvania’s Nursing Homes with Recommendations for Immediate Action.
The report centers the unequal impact of the COVID-19 virus on Black and Hispanic nursing home residents, as well as the underlying quality of care crisis affecting the same populations. Though quality of care and COVID-19 impact all nursing home residents, systemic race-based inequity has created a crisis within a crisis for Black and Hispanic nursing home residents.
“There is a longstanding history of racially segregated and unequal quality of care for Black and Hispanic nursing home residents. This inequality has existed since before Harriet Tubman opened aging facilities for Black Americans with the help of the African Methodist Church,” said Kee Tobar, Director of Race Equity & Inclusion at Community Legal Services of Philadelphia.
Throughout the pandemic, Black and Hispanic people were getting sick and dying of COVID-19 at rates higher than White individuals and at rates higher than their share of the general population. A Kaiser Health Network study of CDC data found that “African Americans ages 65 to 74 died of COVID-19 five times as often as White individuals.”
Comparatively, Black and Hispanic residents, particularly those in nursing homes where they were the majority population, were more likely to have a COVID-19 outbreak, more likely to have a severe outbreak, and more likely to have deaths as a result of COVID-19. Additionally, nursing homes with at least 7 in 10 Black and Hispanic residents saw a death rate that was about 40 percent higher than homes with majority-White populations.
The report recommends a number of ways that Pennsylvania can take immediate and meaningful action to address race-based systemic inequities and the disparities that arise from them. These recommendations can be found on this table, in summarized form in the executive summary, or in the full report.
“Racial and ethnic disparities have long been documented. COVID-19 has removed the veil and made these disparities and the structural racism they are rooted in even more visible. Sadly, we have seen the evidence in the significant loss of black lives during the pandemic. The only way forward is for Pennsylvania to act – equity is the only acceptable outcome,” said Jessica Hartfield, Ombudsman Supervisor at Center for Advocacy for the Rights & Interests of the Elderly
One of the recommendations is to issue regulations to address inadequate staffing levels, infection control requirements, and the numerous other deficiencies that COVID exposed. During the research and writing of this paper, Pennsylvania proposed increasing staffing regulations to 4.1 hours per resident. As nursing homes with primarily Black and/or Hispanic residents are disproportionally understaffed, enacting this proposed regulation would address racial and ethnic disparities in addition to enhancing quality of care for nursing home residents.
Although systemic race-based inequities harm people of all non-white races, most of the available data centers on Black and Hispanic nursing home residents. The report authors found comparatively less data on quality-of-care issues impacting Asian American and Indigenous nursing home residents. Because of this, this paper primarily focuses on the inequity facing Black and Hispanic nursing home residents. However, one of the paper’s recommendations calls for significantly increased and sub-aggregated data on the experiences of Asian and Indigenous nursing home residents, in order to provide for more informed analysis and recommendations in the future.