Researchers at the University of Minnesota are flipping the script on how they study racism in senior care.
A five-year study — funded by a $1.8 million National Institutes of Health grant — will assess racial disparities in nursing homes and how they correlate with resident care and quality of life. The study is part of a growing national awareness of system-wide healthcare disparities based around race.
The University analysis was approved by the school’s Institutional Review Board Tuesday and will build on researchers’ preliminary results, which found lower quality of life in nursing homes with more minority residents.
“[By] bringing attention to the issue, giving voice to these residents [and] identifying some of the mechanisms for this, then we can start addressing these disparities,” said primary investigator and School of Public Health assistant professor Tetyana Shippee.
Her team will interview residents and staff, she said, and observe their interactions to understand how each nursing home functions.
Facilities participating in the study have low resident quality of life scores on the Minnesota Department of Human Services nursing home report card, she said.
The scores are compiled through resident reports about social fulfillment, meal satisfaction and activity engagement, said Bob Held, study advisor and DHS nursing rates and policy division director.
“The focus of the study is what the residents are saying about their own quality of life,” he said, although he added that the findings won’t show individual discrimination.
The research aims to address “system-level factors” that cause the disparities, rather than tracking individual providers, Shippee said.
“Most doctors are not racist,” she said. “It’s the practices that we use in medicine that have these racist factors in place.”
Some nursing homes have lower scores because minority residents may differ from others in how healthy they are overall, Shippee said.
She said facilities with a large proportion of minorities often house younger residents — up to 13 years — who speak a different language or have a mental illness.
Shippee said there will be different research phases over the course of the five-year study.
She said for the first three years, her team will hold interviews and focus groups to gather data and form a statewide analysis. They will then, over the last two years of the study, use their findings for a national examination.
Local issues, nationwide focus
One facility that received a low quality of life score from the annual state report card was The Villa at Bryn Mawr, a Minneapolis-based nursing home.
An administrator at Bryn Mawr, Mike Carlson, said the score is low because of a large number of residents with mental health issues.
“We take a lot of residents that a lot of places aren’t going to take,” he said. “That part can hurt our quality score level.”
Carlson said while the facility has a psychiatrist and psychologist who visit a few times a week, it could use more funding to train staff to help patients suffering from mental illness.
“We’re not a mental health facility, but we take care of a lot of people that might have schizophrenia or bipolar [disorder],” he said.
Structural racism and mistreatment based on race is an issue that is gaining national prominence throughout all healthcare, not just nursing homes.
An article recently published in the New England Journal of Medicine outlined how physicians and other health care practitioners should tackle the issue of health inequalities.
These issues aren't caused by random chance but are a result of structures and systems, such as medical care and public policy, that give privilege based on race, said Rachel Hardeman, a University public health assistant professor and author of the article.
In a 2014 report, the Minnesota Department of Health said that understanding structural racism is crucial in improving healthcare across the state.
“The point is the [bad outcomes don’t] just happen. It happens because of structures that are in place,” she said.
Hardeman said healthcare professionals need to understand the history of inequality in the U.S. to know how disparities in certain diseases — like diabetes — occur more often in minority communities.
Douglas Hartmann, a University sociology professor, said differences in treatment can occur even if individuals don’t hold prejudices. “[S]tructural racism is almost indifferent to that. It’s more about the larger … forces.”
When treating patients, doctors often factor a patient’s race into diagnosis, according to the article.
This kind of metric can be inaccurate because genetic predispositions toward a disease often don’t align neatly with race, said David Satin, a University family medicine and community health assistant professor.
Even classic examples of diagnoses that take race into account, such as sickle cell disease, can’t accurately be attributed to one racial group, Satin said.
“When it comes to things like sickle cell, what we’re after is genetic ancestry. So race is the wrong question,” he said.
For other diseases, the issue isn’t genetic ancestry. Satin said the issue is how society treats certain races, which causes them to have specific diseases at higher rates.
“It’s one thing to say it’s an individual choice to eat bad food but … if you live in a food desert where you don’t have … options anywhere near you, that will make it ten times more likely you won’t abide by the difficult diet,” he said.
Medical professionals can see structural racism because the patients who suffer from diseases caused by social factors are more often minorities, Satin said.
In the future, medicine needs to be more community-improvement based, he said. In addition to the in-hospital physician treatment, community workers are needed to improve health outcomes.
“We [have to] play a bigger game now. Giving the pill and doling out some advice isn’t sufficient,” Satin said. “If we want to get better outcomes … we have to start reaching out into the community to see what we can improve.”