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Geographic Disparities in Access to Nursing Home Services: Assessing Fiscal Stress and Quality of Care

Objective: We test whether nursing homes serving predominately lowincome and racial minority residents (compositional explanation) or located in neighborhoods with higher concentrations of lowincome and racial minority residents (contextual explanation) have worse financial outcomes and care quality.

Data Sources: Healthcare Cost Report Information System, Nursing Home Compare, Online Survey Certification and Reporting Certification, and American Community Survey.

Study Design: A crosssectional study design of nursing homes within U.S. metropolitan areas.

Data Collection/Extraction Methods: Data were obtained from Centers for Medicare & Medicaid Services and U.S. Census Bureau.

Principal Findings: Medicaiddependent nursing homes have a 3.5 percentage point lower operating ratio. Those serving primarily racial minorities have a 2.64point lower quality rating. A 1 percent increase in the neighborhood population living in poverty is associated with a 1.20point lower quality rating, on a scale from 10 to 50, and a 1 percent increase in the portion of neighborhood black residents is associated with a 0.8 percentage point lower operating ratio and a 0.37 lower quality rating.

Conclusions: Medicaid dependency (compositional effect) and concentration of racial minority residents in neighborhoods (contextual effect) are associated with higher fiscal stress and lower quality of care, indicating that nursing homes’ geographic location may exacerbate longterm care inequalities.

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