Reference no: EM133922002

Question

Identify possible policy solutions or industry changes that are needed in response to these problem factors. What are barriers to these policy solutions? Is it lack of need, financial resources, etc.?

Racial and ethnic minorities experience disparities in the quality of care in long-term care facilities. Disparities in long-term care are similar to other health care settings and across the life course. However, specific to long-term care facilities, minority populations have a lower quality of care, poorer quality of life, and less social engagement than the non-Hispanic white population (Mauldin et al. 2020). According to the National Institute of Minority Health and Health Disparities 2018 Research Framework, long-term care health disparities are caused by environmental, sociocultural, and health systems. (Mauldin et al. 2020). Examples of quality-of-care inequities include increased incidence and severity of pressure ulcers, lower flu vaccine uptake rates, and underreporting of psychiatric symptoms of depression. Racial and ethnic minorities are also more likely to experience abuses of resident rights. It was surprising to learn about the direct impact that state and federal LTCF financing policies have on the quality of care for older adults-for example, through Medicaid waivers, some states have been able to innovate LTCFs and target specific areas and populations.

Long-term care facilities are often segregated. Facilities with higher racial and ethnic minorities have reduced staffing levels and more significant survey deficiencies than facilities with larger percentages of non-Hispanic whites. Facilities with a larger percentage of African Americans are admitted to lower quality nursing homes with financial and resource inequities in poorer neighborhoods. Medicaid eligibility, spending, and reimbursement rates vary by state. States with higher levels of racial bias spend fewer dollars per enrollee than those with less racial discrimination. (Leitner et al. 2018, as cited by Mauldin et al. 2020). Medicaid waivers also vary by state related to wealth and size. State and Federal Medicare and Medicaid policies are root causes of ethnic and racial disparities. (Mauldin et al. 2020).

Disparities are prevalent in rural as compared to urban LTCF. The most interesting difference between rural and urban health care is the case-mix in a rural versus urban environment and the lack of impact that the resident population had on contracture rates. Rural residents have more mental illness without physical limitations versus a higher incidence of physical limitations in urban nursing homes. Therefore, I would have expected the contraction rate to increase in urban facilities with residents with more physical limitations. Instead, the contraction rate from 1999 to 2008 increased by 2.2% in the urban environment compared to 3.4% in the rural environment. This finding suggests that the rural setting staff, with residents with fewer physical limitations, may not have the clinical skills to identify and prevent contractures. (Bowblis et al., 2013).

Unique challenges for veterans as they age and enter long-term care facilities occur because they more often have tri morbidities of medical, psychiatric, and social needs. There is an increased instance of veterans that homeless or have housing insecurity. When homeless or housing insecure veterans are discharged from hospitals, they are admitted to long-term care facilities with geriatric conditions at younger ages. Homeless veterans are more likely to enter nursing homes at younger ages, with more significant physical, mental, and substance use with complex social needs.