As the nation’s elderly population increases, nursing homes across the country have seen a demographic shift in their residents. More Hispanic, black and Asian seniors are moving into nursing homes, while white seniors choose other options.
A study by Brown University researchers published in the journal Health Affairs found that this nationwide trend is driven in part by changing demographics, such as the rapid growth of elderly minority populations.
But the study also found that the increase in the proportion of minority nursing home residents indicates a lack of access to home- and community-based alternatives, which generally are preferred for long-term care. Whites seniors, who have greater economic resources on average, are finding better housing alternatives as they reach old age.
“We know those alternatives are not equally available, accessible or affordable to everybody, certainly not to many minority elders,” said Zhanlian Feng, an assistant professor at Brown University's Center for Gerontology and Health Care Research and the study’s lead author. “Most elders would rather stay in their homes or some place like home, but not a nursing home unless they have to.”
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The researchers found that between 1999 and 2008, the number of elderly Hispanics living in U.S. nursing homes climbed by 54.9 percent, while the number of Asians increased by 54.1 percent. The number of black residents rose 10.8 percent. During the same 10-year period, the number of white nursing home residents in the U.S. dropped by 10.2 percent.
In the Los Angeles/Long Beach region, the residency increases also were significant, with a 56 percent increase in the Asian population and 41 percent rise among Hispanics. The increase for blacks was slight, only 1 percent.
Patricia McGinnis, executive director of California Advocates for Nursing Home Reform, agreed that minorities as a group tend to be less able to afford residential care facilities or home care aides, who charge about $15 to $20 an hour.
California has more than 7,600 residential care facilities, up from about 5,500 a decade ago, she said. The average rate for those facilities, which generally offer more freedom and personal attention to residents, can be $5,000 a month.
“Let's face it: Money issues and a disparity in income and assets in minority communities is still there,” McGinnis said. “Unless you have savings, people are priced out of the market.”
To conduct the study, Brown researchers used data from a federal survey, which collects periodic information on nursing home residents: their race, ethnicity, the size of their population and where in the U.S. they live. The researchers used data from the Census Bureau’s Metropolitan Statistical Areas to gather information on the racial and ethnic mix of nursing home residents and the demographic shifts in urban areas.
These demographic shifts in the composition of nursing home populations are taking place within a rapidly shifting long-term care landscape. There are 76 million baby boomers in the nation; the oldest of them turn 65 this year. The Census Bureau projects that by 2030, 20 percent of the U.S. population will be 65 or older. Today, that figure is 13 percent.
The population of older minorities is slated to grow particularly swiftly. The number of older Hispanics, for instance, is projected to jump from fewer than 1.8 million in 2000 to more than 8.6 million by 2030. The number of elderly Asians is expected to balloon from 0.8 million to 3.8 million.
At the same time, elderly people don’t have the support at home or the social structures of previous generations. People don’t live as close to their relatives as they did in the past. Couples are having fewer children, and often adult children have to work outside the home and are unable to provide full-time care to elderly or ill parents.
These dramatic societal changes have prompted the government to alter certain policies and priorities. There has been a shift in support from nursing home care to favoring home- and community-based services, the study said, which cost less than institutional care. A significant change was the passage of the Medicaid waivers authorized in 1981 in the Social Security Act. Waivers allow recipients to use their Medicaid dollars to pay for personal care and other supportive services, enabling more beneficiaries to live at home or in a residential setting.
Older adults and those with disabilities prefer living independently at home or in community-based alternatives, according to a related study published in Health Affairs that examined what people want from long-term care. Assisted living allows people to have more freedom; a skilled nursing facility is more confined and has more supervision.
The Brown University study cites earlier research, which shows that minorities, even if they had the means, have other disadvantages when it comes to finding quality care. Nursing homes in largely minority areas often are of lesser quality and are more likely to close, while assisted living facilities are more likely to proliferate in high-income areas.
Eli Quinones, president and CEO of Alliance Nursing Centers Inc., operates three nursing homes in El Monte. He said the residents of his nursing homes, 90 percent of whom are Chinese, tell him they feel safer and more comfortable in his facilities. But Quinones said that in his industry in general, he sees how the cost of care can be a factor in the demographic makeup of a nursing home population.
“Assisted living has become quite popular, and it’s also very expensive,” he said. “When it comes to economics, white folks are able to afford a different level of care.”
This story also was published at HealthyCal.org, a nonprofit health journalism site.