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Collaborative study aims to reduce racial disparities in nursing homes, improve quality of life

Photo: Creative Commons, Deb Stgo,

The University of Minnesota’s School of Public Health will lead a comprehensive study of racial disparities in nursing homes and how that relates to quality of life and quality of care.

This expands on the team’s preliminary findings, which identified minority nursing home residents had markedly lower quality of life, despite accounting for a host of other factors. The study is funded by the National Institute on Minority and Health Disparities through the National Institutes of Health (NIH), totaling to about $1.8 million in grant funding over the course of five years.

“This has not been studied comprehensively before,” said primary investigator, Tetyana Shippee, Ph.D., assistant professor in the School of Public Health. “There is a major demographic shift happening in nursing homes, but we know so little about quality of life and quality of care for those populations.”

By 2030, minorities are expected to be overrepresented in nursing homes. In fact, from 1998 to 2008, Hispanic and Asian individuals living in nursing homes increased more than 50 percent, and African-American people living in nursing homes increased by 10 percent.

The number of elderly in long-term care facilities is projected to grow dramatically. In fact, the U.S. Department of Health estimates that 70 percent of Americans over the age of 65 will require long-term care at some point.

If unaddressed, the quality of life gap is likely to increase.

“This gap is concerning. Minnesota is ranked first in the nation for quality of life and quality of care on the AARP scorecard for long-term care. If we’re seeing unmet needs here, that disparity is likely even greater throughout the country,” Shippee said.

Two years ago, Shippee participated in the Clinical Translation Science Institute (CTSI)’s KL2 Scholars Career Development Program, which helped set the stage for this grant award.

“Thanks to CTSI and its commitment to advancing researchers’ careers, I could develop the expertise and connections I needed to be scored so highly on an R01 application as a junior investigator,” Shippee said.

It also opened opportunities for collaboration and allowed her the time to build relationships with the Minnesota Department of Human Services, which will partner with her on the project to work with nursing homes throughout the state.

“Nursing home residents’ quality of life – including their social connections, comfort, satisfaction with meals and sense of being treated with respect and dignity ­– is of paramount importance to the Minnesota Department of Human Services as a primary purchaser of nursing home services in the state,” said Bob Held, director of the DHS Nursing Facility Rates and Policy Division.  “We are hopeful this project will help to ensure a high quality of life that is culturally and linguistically appropriate for all residents of Minnesota nursing homes.”

Valerie Cooke and Antonia Wilcoxon with the DHS will also collaborate on the study.

The team will interview residents, nursing home administrators and care providers about their experiences, attitudes, values and challenges within a long-term care setting. This qualitative data will allow them to evaluate and develop strategies for implementing change into the system to improve quality of life among all ethnic and racial groups. Qualitative findings will also inform further quantitative analyses both in Minnesota and nationally.

They will also reach out to community leaders and organizations to engage the surrounding neighbors and residents outside of the nursing homes.

“Our preliminary work showed nursing homes with a higher percentage of minority residents had lower quality of life scores, even when the majority of these facilities provided adequate quality of care. Yet most of these facilities were located in poorer neighborhoods, pointing to the likely relationship between place of residence and quality of life,” Shippee said.

Shippee hopes engaging with the community could integrate residents into the neighborhood and create a stronger sense of belonging.

“We need to acknowledge these disparities; just ignoring the issue won’t solve anything,” Shippee said. “By bringing everyone to the table, we can identify what’s contributing to this gap and make significant changes to improve the lives of our aging population.”

Speaking for the Voiceless: Tetyana Shippee changes the way we think about long-term care

CTSI research career development program helps U junior investigator secure $1.77 million grant

  1. January 24, 2017 7:13 am | Danitra Easton-Hage Says:

    I agree with the need to study the care for the elderly. Making vast changes to the system for programming and funding. Two years ago at age 80 my mother African-American suffered a major stroke after having worked in government for over 34 years and working and serving her community for many years after retirement as an ordained minister and Bible teacher we found the need to have her go into assisted living. Initially after her stroke she was sent to transitional living rehabilitation center were she spent the allowable two months in intense rehabilitation therapy. The transitional care facility wanted her to move into a nursing home situation because she had plateaued and needed to be placed in another long-term facility with the care of minimum requirement of two people to provide care and assistance. Of course many of the elderly want to remain in their own home and not be placed into any facility because of the stigma shown or proven to be less than or substandard to those who could afford top premium care and top premium facilities; typically non-minorities.

    Usually, and unfortunately the remaining family members bears the burden of caring for their elderly or sick by family members pitching in housing and providing cares. Sometimes this means rotating their love ones throughout other family members homes to be able to provide some sort of respite and relief because caring for the elderly can be quite daunting. At age 56 my mother had brought her last living relative up from Chicago to provide a safe place and provide health care for him in her home, because his wife had deceased and she (my mother) was his last remaining family member. It was heart breaking to find that his wife’s relatives were taking his VAPension spending it on themselves and not providing his basic care needs. He had surffered a stroke in his early years, but could walk and move around independently. As his care needs progressed, it became necessary to move him to a assistant living nursing home which was subsidized by the VA, but was also in the community in the inner city of St. Paul were my mother resided. However, the place was reallly not great, smelled like a nursing home, and battled roaches.

    When my mom was told she would need 24/7 care of course it was devastating to hear she could no longer be independent, but even more so that she required 2 people 24 hours a day. Meaning not even a family member could provide the type of care she neeeded. Well because she had a good government pension and a home she owned, we were able to secure her in a facility were she has been the only miniority. Which bothered me that no other minorities were in the facility because their policy is that you have to private pay two years before they will except any funds from the state to pay for cares. I found it highly insulting because it’s a way of subtly keeping out minorities from being able to have adequate care in a more adequate facility. But, they told us that if we could private pay for two years, then she could stay. Well I did the math and figured that if we sold her home along with her pension we could probably squeak by to be able to pay out-of-pocket the over $6000 a month for her cares which fluctuate drastically each month depending on how they determine what special needs they had to provide in addition to what is normally provided. The really sad part is that I have been providing her bathing care needs for her entire time there as well as doing her laundry which is almost an every other day occurrence with heavy loads because of her incontinence and need of tolieting, and dependent on the aids getting there in time to keep her from soiling her clothes. More so then not the are too busy to get there in time, or she not able to go at her scheduled time, which you can’t tell the body that everyday at 6am, noon, after dinner and before bed you can urinate. Anyway, they told me it would save cost since a lot of their care needs are on an à la cart basis in addition to the monthly rent for room and board and medication packages for administrating medicines. However, I’ve been going along with their program because she really didn’t have many options and I really needed to stretch her money by taking on those duties because her bill is always high and fluctuate always based on their evaluation of what was needed that month. Of course I wonder if I’m saving money, because the keep the bill high no matter what. I’m hurt by this whole process and really feel that I’m just saving them time for giving her baths and doing her laundry; although baths are charge $24 dollars and laundry charge at $12 to wash and $12 to dry a load of clothes, but honestly no reflection in the bill. When I’ve complained about the billling, it’s a no win situation for us, well I can’t have her living on the street.

    Anyway, it’s been the two years and she is broke and now I will be applying for the elderly waiverly program, to get her subsidy, I know they will be taking her retirement to fund the subsidy and provide her care, but my hopes are that she can remain were she is.

    Something has to be done for the elderly, I’m 60 myself and my other baby boomer friends are facing these same issues now with their mothers. Something has to be done to bring the current facilities up to a higher level standards for minorities across the board, and cost efficiencies for all.

  2. March 30, 2017 3:55 pm | Stellamaris Says:

    I am a public health student about to graduate with my master’s degree in August 2017. I believe that the need to help seniors close to their home, by keeping them up in the morning and dropping them off in the evening will help maintain wellness and independent living.

  3. November 9, 2017 11:09 am | Ann Smith Says:


    I am a doctoral student located in Florida as well as a State Ombudsman. I share the intense frustration of the daughter whose mother is in a skilled nursing facility. I was a Business Office Manager for ten plus years and I know firsthand the experiences families face. I decided to do something about it, so I went back to college to further my studies and I recently graduated with a Masters degree in Health Administration and am working on my dissertation.
    It will be a tool specifically geared toward African Americans transitioning from skilled care to home. I have found while being an Ombudsman that there is a gap in communication for adult children, their families as caregivers and information post discharge.
    It is more critical for the resident when he/s returns home. There is a lack of services which possibly generates more admissions to emergency rooms and readmissions into the hospital. If older adults were able to “age in place” which is defined as living in their home and receiving services, perhaps this may alleviate the stressors on the family. While this is an assumption, my research will seek to explore these avenues. My plans are to create and develop some form of an action plan to assist the African American community with quality services and better understand the choices they make as it pertains to insurance policies however not limited to second and third-degree relatives. It is important to note that health illiteracy is a huge communication issue for African Americans too.
    I am optimistic about the outcome in future studies as well.