A new study from the School of Public Health has identified differences in quality of life (QOL) between white and racial/ethnic minority residents living in nursing homes in Minnesota. Compared to white residents in nursing homes, racial/ethnic minority residents have a significantly lower QOL, regardless of the ratio of minority residents at the facility. The findings reveal the need to improve the care of racial/ethnic minority residents — especially during the COVID-19 pandemic.

The study was published in the journal Innovation in Aging and led by Associate Professor Tetyana Shippee.

“We saw that in every respect, Black and indigenous residents had lower satisfaction with various aspects of their lives in nursing homes than white residents,” says Shippee. “And now in a time of extreme isolation due to COVID-19, quality of life among Black, indigenous and other residents of color could be getting even lower.”

The study examined interviews completed prior to the pandemic from a diverse group of more than 11,000 residents living in each of Minnesota’s Medicare/Medicaid certified nursing homes. The researchers asked the residents questions related to QOL and then correlated them with their health records and the features of their nursing homes. The survey measured six categories of QOL for nursing home residents: the nursing home environment, social engagement, attention from staff, food enjoyment, negative mood, and positive mood. Minnesota is one of two states to collect validated measures of nursing home quality of life, besides Ohio.

The researchers found:

• Minority residents reported lower levels of satisfaction than white residents in all aspects of nursing home life, indicating a significantly lower QOL;
• minority residents reported similar levels of dissatisfaction in facilities with low- or high-minority populations;
• white residents reported a lower QOL when they lived in high-minority facilities; 
• the largest gaps in satisfaction between racial/ethnic minority and white residents were found in food enjoyment, social engagement, and attention from staff.

“Overall, residents of nursing homes with a higher percentage of Black, indigenous and other residents of color reported significantly lower QOL scores,” says Shippee. “Our work shows that even though there are presumed benefits of social cohesion for residents of color who live in high-proportion minority facilities, they do not offset the systemic disparities that residents of color and indigeous residents experience in long-term care system.”

These differences might be due in part to the demographic characteristics of minority residents in high-minority nursing homes. These residents were considerably younger and more likely to have diagnoses of serious mental illness and behavioral problems. The differences may also be a product of the environment of the nursing homes themselves. High-minority nursing homes were typically larger and for-profit, more reliant on Medicaid reimbursement, and often had lower staffing levels. Yet, even accounting for these observed factors, racial, and ethnic differences in QOL remained significant. 

“The results suggest a gap in the individual care needs of residents of color and indigenous residents in nursing homes and emphasize the need to develop culturally sensitive care to improve QOL for them,” says Shippee.

Shippee also believes these findings have implications for the racial and ethnic disparities that have begun to emerge during COVID-19. 

“If we see these disparities in social engagement and relationships under normal circumstances, it is likely Black, indigenous, and other residents of color may be at a particularly high risk of poor quality of life during COVID-19 isolation,” says Shippee.

The researchers recommend that other states conduct similar studies to gather comprehensive data on the most important barriers and facilitators of QOL in nursing home residents from diverse racial and ethnic backgrounds. Such studies could help inform policies that incorporate QOL scores as a measure of quality for nursing homes nationally.