Racial and ethnic minority users of long-term services and supports at assisted living communities, nursing homes and other settings are at increased risk during the coronavirus pandemic due to individual and system-level factors, and the barriers that increase their risk will remain without improved policies, according to researchers at the University of Minnesota School of Public Health.

They presented their findings in an article published online May 31 by the Journal of Aging and Social Policy.

The pandemic, the researchers said, highlights the role of social support and isolation — important factors in racial and ethnic disparity in quality of life — and the crisis spotlights challenges faced by long-term care staff members, particularly immigrants and those from communities of color.

“The racial and ethnic disparities across LTSS facilities are not due to race, but institutional racism built into the health care sector and other areas that lead to minority communities having worse health outcomes,” study lead Tetyana Shippee, Ph.D., associate professor at the University of Minnesota School of Public Health, said in a statement. “It’s time for policymakers to share data to learn about and address the system-level issues that drive racial and ethnic disparities and create gaps in quality for minority long-term care facility users.”

Researchers reviewed existing studies and reports on national COVID-19 disparities in long-term care facilities, and they supplemented it with data from their own work, to identify proposed action steps to address those disparities. Their recommendations:

  • Report COVID-10 data in LTSS by race/ethnicity.
  • Establish priority testing, adequate personal protective equipment and other supports for high-proportion minority assisted living communities and nursing homes.
  • Address existing racial/ethnic disparities in facilities.
  • Include quality of life measures, such as emotional well-being of residents, as a key metric of LTSS quality.
  • Improve pay and work conditions for direct care staff.

The authors state that long-term care settings are characterized by racial and ethnic disparities in financing, access, quality and service delivery.

“These disparities are likely to increase during the COVID-19 pandemic, with emerging data that show people of color and indigenous people have a higher burden of illness and death from COVID-19 than their white peers,” the study states. “Furthermore, the pandemic is bringing to light the gaps in care due to already existing racial and ethnic disparities in LTSS and provides an opportunity to advance equity in LTSS during the pandemic and beyond.”

Existing barriers that lead to racial/ethnic disparities in the context of COVID-19, according to the study, include:

  • Cumulative health disparities for minority populations over their lifetimes.
  • Unequal clinical care and quality of life for nursing home users from communities of color.
  • Impediments to quality experienced by low-English proficiency nursing home users
  • Inordinate impact on care quality due to challenges faced by an LTSS workforce that is disproportionately composed of immigrants and racial/ethnic minorities.
  • Disparities in home and community-based services.

Researchers said they hope the study, funded by the National Institute of Minority Health Disparities, builds momentum toward addressing health equity in long-term care.

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