Summary
This article in The Journal of Post-Acute and Long-Term Care Medicine looks at the issue of systemic racism in long-term services and supports (LTSS) including nursing homes and home- and community-based care in the USA. The authors highlight segregation and disparities, with Black, Indigenous, and persons of colour (BIPOC) users having less access to quality care and reporting poorer quality of life.
The authors make a number of policy recommendations to address these health inequalities in LTSS:
- Targeted increases to Medicaid reimbursement tied to direct care, and targeted enhanced Medicare and/or Medicaid reimbursement to LTSS providers that serve a disproportionate share of Medicaid or underserved older adults.
- Pay for performance incentives should focus on improving care among LTSS providers who serve individuals with disadvantaged status because of systemic racism and that operate above and beyond a person's clinical severity and comorbidity.
- The Centers for Medicare & Medicaid Services (CMS) should develop an overall health equity measure which would help capture how well providers meet the needs of diverse populations. Care Compare quality scores by race and ethnicity should be used internally and shared with states to develop culturally appropriate policies. Race and ethnicity-specific quality measures should be included on state-level report cards to incentivise action among states and tailor solutions to the local context.
- Promote culture change in nursing homes, with an ultimate goal of creating a person-centred, homelike model of care.
- Expand access to Medicaid-waivered home- and community-based services.
- Ensure that home- and community-based services are culturally appropriate.
- Promote integrated home- and community-based programs that can be targeted to BIPOC users to address existing disparities in outcomes.
Evidence for action: addressing systemic racism across long-term services and supports (1 February 2022)
https://www.jamda.com/article/S1525-8610(21)01070-7/fulltext#%20
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