Racial minorities account for roughly 16% of the U.S. nursing home population. As more facility- and resident-level data have become available, racial disparities in nursing homes have become a greater focus for health policy analysts. Existing studies have found that blacks are more likely than whites to reside in nursing homes with fewer nurses, poorly trained executive staff, and a greater number of regulatory deficiencies. The purpose of this study is to examine whether racial disparities occur in potentially preventable emergency department visits. Using the 2004 National Nursing Home Survey, I constructed a logistic regression model to examine the extent to which race and other variables - sex, age, any falls or fractures in the 6 months prior to interview, payment source, facility ownership type, and facility location - are associated with potentially preventable emergency department visits. The regression results did not find a statistically significant relationship between race and potentially preventable emergency department visits. While this finding did not support the study's hypothesis, the analysis did present suggestions for further research. Including additional questions in future surveys could contribute to a broader understanding of racial disparities in U.S. nursing homes, such as asking residents if they feel discriminated against by health care providers or other staff or if they feel they can openly engage in cultural activities. Answers to questions of this type may help determine if discrimination exists and in what ways it is manifested.

KEY FINDINGS: Data from the National Nursing Home Survey, 2004. In 2004, 8 percent of U.S. nursing home residents had an emergency department (ED) visit in the past 90 days. Among nursing home residents with an ED visit in the past 90 days, 40 percent had a potentially preventable ED visit. Injuries from falls were the most common conditions accounting for potentially preventable ED visits by nursing home residents. Nursing home residents who had a potentially preventable ED visit in the past 90 days had shorter lengths of stay and more medications In 2004, 8 percent of U.S. nursing home residents had an emergency department (ED) visit in the past 90 days. Among nursing home residents with an ED visit in the past 90 days, 40 percent had a potentially preventable ED visit. Injuries from falls were the most common conditions accounting for potentially preventable ED visits by nursing home residents. Nursing home residents who had a potentially preventable ED visit in the past 90 days had shorter lengths of stay and more medications.

"This open access book outlines the challenges of supporting the health and wellbeing of older adults around the world and offers examples of solutions designed by stakeholders, healthcare providers, and public, private and nonprofit organizations in the United States. The solutions presented address challenges including: providing person-centered long-term care, making palliative care accessible in all healthcare settings and the home, enabling aging-in-place, financing long-term care, improving care coordination and access to care, delivering hospital-level and emergency care in the home and retirement community settings, merging health and social care, supporting people living with dementia and their caregivers, creating communities and employment opportunities that are accessible and welcoming to those of all ages and abilities, and combating the stigma of aging. The innovative programs of support and care in Aging Well serve as models of excellence that, when put into action, move health spending toward a sustainable path and greatly contribute to the well-being of older adults."--Provided by publisher.

Rural-urban disparity has been a longstanding issue in the United States. Nursing home (NH) residents are at high risk of having emergency department (ED) visits, but evidence on rural-urban disparity in ED visits is very limited. Medicaid reimbursement rates and bed-hold policies have been shown to affect hospitalizations of urban NH residents, but their effects on ED visits and rural NHs remain unknown. This study analyzed 2011?2013 national Medicare claims, NH Minimum Data Set 3.0 assessment data, the Certification And Survey Provider Enhanced Reporting data, Area Health Resources File, Rural-Urban Commuting Areas Codes, and state Medicaid policies. We constructed and validated three NH-level risk-adjusted rates of long-stay residents: any ED visit, ED visits without hospitalization or observation stay (outpatient ED), and potentially avoidable ED visits (PAED). We then examined rural-urban differences in ED rates, and conducted Blinder-Oaxaca decompositions to understand the mechanism driving the differences. We also evaluated the different effects of Medicaid reimbursement rates and bed-hold policies on three risk-adjusted rates of ED visits for rural vs urban NHs. The risk-adjusted rates averaged 9.7%, 3.4%, and 3.2% for any ED visit, outpatient ED, and PAED, respectively. Compared to urban NHs, rural NHs were associated with much lower rates of any ED, outpatient ED, and PAED. Observable differences in market factors and NH characteristics significantly explained rural-urban differences in rates of various ED visits. More generous Medicaid rates were associated with lower rates of all types of ED visits, and Medicaid bed-hold policies were associated with higher rates of ED visits in urban NHs. However, effects of Medicaid NH policies on ED utilization were weaker in rural NHs than urban NHs. To the best of our knowledge, this is the first study to systematically examine rural-urban differences in rates of various ED visits, and also the first to examine the effects of Medicaid policies on ED visits for rural and urban NHs. Our study emphasizes the importance of addressing special challenges faced by rural NHs such as limited access to hospital services and shortage of qualified staffing, which might be more critical than Medicaid reimbursement rates in improving NH quality as evident by ED use.

The Centers for Medicare & Medicaid Services (CMS) have been moving from volume-based, fee-for-service payment to value-based payment (VBP), which aims to improve health care quality, health outcomes, and patient care experiences, while also controlling costs. Since the passage of the Patient Protection and Affordable Care Act of 2010, CMS has implemented a variety of VBP strategies, including incentive programs and risk-based alternative payment models. Early evidence from these programs raised concerns about potential unintended consequences for health equity. Specifically, emerging evidence suggests that providers disproportionately serving patients with social risk factors for poor health outcomes (e.g., individuals with low socioeconomic position, racial and ethnic minorities, gender and sexual minorities, socially isolated persons, and individuals residing in disadvantaged neighborhoods) may be more likely to fare poorly on quality rankings and to receive financial penalties, and less likely to receive financial rewards. The drivers of these disparities are poorly understood, and differences in interpretation have led to divergent concerns about the potential effect of VBP on health equity. Some suggest that underlying differences in patient characteristics that are out of the control of providers lead to differences in health outcomes. At the same time, others are concerned that differences in outcomes between providers serving socially at-risk populations and providers serving the general population reflect disparities in the provision of health care. Systems Practices for the Care of Socially At-Risk Populations seeks to better distinguish the drivers of variations in performance among providers disproportionately serving socially at-risk populations and identifies methods to account for social risk factors in Medicare payment programs. This report identifies best practices of high-performing hospitals, health plans, and other providers that serve disproportionately higher shares of socioeconomically disadvantaged populations and compares those best practices of low-performing providers serving similar patient populations. It is the second in a series of five brief reports that aim to inform the Office of the Assistant Secretary of Planning and Evaluation (ASPE) analyses that account for social risk factors in Medicare payment programs mandated through the Improving Medicare Post-Acute Care Transformation (IMPACT) Act.