Evidence for Action: Addressing Systemic Racism Across Long-Term Services and Supports

Tetyana Pylypiv Shippee, Chanee D. Fabius, Shekinah Fashaw-Walters, John R. Bowblis, Manka Nkimbeng, Taylor I. Bucy, Yinfei Duan, Weiwen Ng, Odichinma Akosionu, Jasmine L. Travers

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Long-term services and supports (LTSS), including care received at home and in residential settings such as nursing homes, are highly racially segregated; Black, Indigenous, and persons of color (BIPOC) users have less access to quality care and report poorer quality of life compared to their White counterparts. Systemic racism lies at the root of these disparities, manifesting via racially segregated care, low Medicaid reimbursement, and lack of livable wages for staff, along with other policies and processes that exacerbate disparities. We reviewed Medicaid reimbursement, pay-for-performance, public reporting of quality of care, and culture change in nursing homes and integrated home- and community-based service (HCBS) programs as possible mechanisms for addressing racial and ethnic disparities. We developed a set of recommendations for LTSS based on existing evidence, including (1) increase Medicaid and Medicare reimbursement rates, especially for providers serving high proportions of Medicaid-eligible and BIPOC older adults; (2) reconsider the design of pay-for-performance programs as they relate to providers who serve underserved groups; (3) include culturally sensitive measures, such as quality of life, in public reporting of quality of care, and develop and report health equity measures in outcomes of care for BIPOC individuals; (4) implement culture change so services are more person-centered and homelike, alongside improvements in staff wages and benefits in high-proportion BIPOC nursing homes; (5) expand access to Medicaid-waivered HCBS services; (6) adopt culturally appropriate HCBS practices, with special attention to family caregivers; (7) and increase promotion of integrated HCBS programs that can be targeted to BIPOC consumers, and implement models that value community health workers. Multipronged solutions may help diminish the role of systemic racism in existing racial disparities in LTSS, and these recommendations provide steps for action that are needed to reimagine how long-term care is delivered, especially for BIPOC populations.

Original languageEnglish (US)
Pages (from-to)214-219
Number of pages6
JournalJournal of the American Medical Directors Association
Volume23
Issue number2
DOIs
StatePublished - Feb 2022

Bibliographical note

Funding Information:
This work was supported by the National Institutes of Health-National Institute on Minority Health and Health Disparities (grant no. R05MD010729) and by the National Institute on Aging (grant no. 1RF1AG069771-01) to T.P.S.

Funding Information:
This work was supported by the National Institutes of Health- National Institute on Minority Health and Health Disparities (grant no. R05MD010729 ) and by the National Institute on Aging (grant no. 1RF1AG069771-01 ) to T.P.S.

Publisher Copyright:
© 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine

Keywords

  • Systemic racism
  • disparities
  • equity
  • long-term services and supports
  • policy

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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