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The surprising racial division of the impact of COVID-19 in nursing homes

An elderly woman with a face mask waits to be treated in New York (Reuters)
An elderly woman with a face mask waits to be treated in New York (Reuters)

In the Baltimore suburbs, workers at a nursing home said they were given rain ponchos to protect themselves from infection. After a time, 27 employees at the site, where the majority of residents are African-American, tested positive for the coronavirus.

One of the many black residents of a nursing home in Belleville, Illinois, passed away in April amid a coronavirus outbreak. However, her niece reported that her uncle was never tested for the virus.

In East Los Angeles, a worker at a predominantly Latino nursing home where there was an outbreak, claimed she was given swimming goggles before the administration could obtain professional protective equipment. Later, he claimed that he tested positive for the virus.

The coronavirus pandemic has devastated the nursing homes in the country. It has sickened staff, devastated residents, and contributed to at least 20 percent of the total death toll from COVID-19 in the country. The impact has been felt in cities and suburbs, in large and small facilities, in nursing homes with very low ratings and in those with stellar reviews.

However, COVID-19 has been particularly ruthless towards African Americans and Latinos. Nursing homes where those groups make up a significant portion of residents - regardless of their location, size, or government classification - have had the twice as likely to be affected by the coronavirus than those where the population is mostly white.

More than 60 percent of nursing homes where at least a quarter of residents are of African-American or Latino origin have reported at least one case of coronavirus, according to an analysis by The New York Times. That's double, compared to the nursing home index where black or Latino people make up less than 5 percent of the population. In nursing homes, a single case usually leads to a handful and then ends in a total outbreak of cases.

Geriatric Hospital in Willowbrook, Illinois (Reuters)
Geriatric Hospital in Willowbrook, Illinois (Reuters)

The country's nursing homes, like many of its schools, churches, and neighborhoods, are widely segregated. Those who primarily serve black and Latino residents tend to receive fewer stars on government rankings. Those facilities also tend to house more residents and be located in urban areas, which are risk factors for the pandemic.

However, Outbreak inequalities in nursing homes with more Latino and black residents have also developed in confusing ways that experts say are difficult to explain..

The race and ethnicity of the people living in a nursing home were indicators of whether or not that place would be affected by COVID-19. However, the Times' analysis found that the federal government's five-star rating system, generally used to judge the quality of a nursing home, was not a predictor. The data showed that even the nursing homes with predominantly black and Latino populations with high classifications were more likely to be affected by the coronavirus than those with low classification with a mostly white population.

To better understand the disparities in Maryland, Illinois, and California, the Times partnered with The Baltimore Sun, KPCC / LAist, and The Southern Illinoisan to interview dozens of current and former nursing home workers, residents, and their families.

The data reveals that the coronavirus has been infecting and killing people of color at disproportionately high rates in the United States. Senior managers in the nursing home industry claim that situations within nursing homes largely reflect circumstances that unfold beyond its walls.

"Normally what happens in the general population is reflected in long-term care facilities," said David Gifford, medical director of the American Health Care Association, which represents the industry. Nursing homes within communities that have been at risk from the virus are more likely to have outbreaks, Gifford said, especially in large residences where many employees enter and leave.

Small nursing homes, which house mostly white residents, tend to have fewer outbreaks than larger facilities. Nursing homes in cities have more outbreaks than those located in suburbs or rural areas.

However, the analysis of Times he discovered that racial disparity persisted even after accounting for a variety of factors, including the size of a nursing home, infection rate in the surrounding county, population density of the neighborhood, and how many residents had Medicaid or Medicare.

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Large nursing homes with few black and Latino residents were less likely to have outbreaks than similar nursing homes with more black and Latino residents. A nursing home in an urban area was less likely to be hit by the virus if it had a small black and Latino population.

Transfer of a nursing home resident in San Antonio, Texas (Reuters)
Transfer of a nursing home resident in San Antonio, Texas (Reuters)

The analysis of Times, which covers the 22 most affected states for which data is available, plus the District of Columbia, is a frozen-in-time image, and that image could change as the crisis continues. Based on data collected through May 16, the analysis was unable to determine if there was a disparity in illness or death rates for white residents and people of color within nursing homes, because those data were not available.

About 1.3 million people live in the country's nursing homes, according to federal data. Close to 80 percent of those residents are identified as targets by nursing home administrators.

Long before the pandemic, there was already a disparity in nursing homes. Those centers with more black and Latino residents tended to have lower scores than mostly white households, according to the quality metrics used by regulators. Furthermore, they were more likely to have been penalized for serious rule violations.

Nationwide, at least 106,000 people have been affected by the virus in more than 4,000 specialized care centers, which do not include autonomous assisted living centers, retirement communities, and other long-term care facilities. Almost 19,000 people have died, and that number is quite likely well below reality. All types of nursing homes, including those with a majority of white residents, have been affected.

In Maryland, 80 percent of nursing homes with predominantly black and Latino populations have suffered from coronavirus, a rate twice as high as that of nursing homes where there are almost no such residents.

Medical workers at a rally outside a nursing home in Baltimore, Maryland (Reuters)
Medical workers at a rally outside a nursing home in Baltimore, Maryland (Reuters)

At some facilities that had outbreaks of coronavirus, there were already concerns, long before the virus, about the way residents were being cared for. The Bria of Belleville center in southern Illinois has been linked to at least 22 cases and two deaths. It is one of the more than 300 nursing homes in the state where the virus has been detected. Bria, where many of the residents are black, has an overall one-star rating, the lowest possible, given by the federal government.

Juanita Willis helped care for her uncle Ralph Wellmaker, who had lived in that residence since last summer. Willis said he had expressed concern about the health services and staff at the nursing home, and described the care there as "simply horrendous."

Willis, a nurse at a medical center in San Luis, is not sure if her uncle had the virus. He last visited him in early March, shortly before visitors were asked to stay away from the site. In mid-April, he received a call from a hospital social worker, asking about his uncle's funeral arrangements. This is how he learned that his uncle had died two days earlier. Her death certificate indicated that the cause of death had been cardiac arrest, but records indicate that she was not tested for the virus, according to the local coroner's office.

"It is very disturbing," Willis said. "I think once they had the first case, they should have done the diagnostic test on everyone in the nursing home."

In a statement, Bria authorities defended the quality of care at its Belleville facility. They pointed out the difficulties in obtaining evidence of the coronavirus and claimed that Wellmaker lived in a part of the center separate from people known to have the virus.

"The Bria of Belleville Center took timely and aggressive measures to protect the health and safety of all its residents and staff," Stephanie Birch, the center's administrator, said in a statement.

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Along with nursing home residents, thousands of nurses and assistants have caught the virus, in an industry where African-Americans make up a huge proportion of the workforce.

(Reuters)
(Reuters)

Dozens of geriatric workers interviewed across the country described disorganized and understaffed residences, where they sometimes lacked the necessary protective equipment amid the pandemic. The workers became ill with their patients.

In Baltimore County, at the Forest Haven Extended Care and Rehabilitation Center, where many of the residents are African-American, workers claimed that in early April, after Maryland required all nursing homes to provide them with protective equipment To their staff, what they received were rain ponchos and nylon hair caps.

Since then they have received adequate supplies, including masks, face masks, and gowns. But at least 97 people, including 27 workers, have contracted the virus, and eight residents have died.

Ron Colbert, the center's administrator, said the nursing home was restricting visitor access, screening all who enter for symptoms and following federal guidelines for personal protective equipment and patient isolation. When asked in an email about ponchos and nylon hats, Colbert did not respond.

In East Los Angeles, at the Buena Ventura Recovery Intensive Care Center, a five-star residence where many residents are Latino, Alma Lara-Garcia, a certified nursing assistant, said workers did not receive a mouthpiece until April, when the epidemic was well underway in the United States.

Lara-Garcia said administrators told her they were going to request medical-grade eye protection, but the providers were no longer in stock. Instead, he said, they gave him orange plastic swimming goggles. The glasses did not fit under his glasses, so he did not use them.

Soon after, she said, she began to feel sick. According to Lara-García, they told him to keep going to work anyway. Days later, she said, she was sent home when she complained of an uncontrollable cough and sore throat. Eventually, she tested positive for the virus at a county-run testing center.

Tiana Thompson, administrator of Buena Ventura, stated that the center had worked to obtain protective equipment for its employees and that Lara-Garcia had not been asked to go to work when she was sick.

"The Buena Ventura Recovery Intensive Care Center has never asked any employee who reported having COVID-19-related symptoms to continue working," Thompson said in an email.

At least 83 residents and employees have contracted the virus, and at least a dozen of them have died.

How were the numbers calculated?

When examining the racial disparity in coronavirus infections in nursing homes, The New York Times compiled information from infection reports from state and local health agencies and collated the information with informative databases on the centers, including clusters Data from the federal government's Nursing Home Comparison and Brown University Focus on Long-Term Care data.

Although the analysis could not fully explain why some nursing homes have had outbreaks and others have not reported any infection, it was able to identify some variables that increased the probability that a nursing home would report a problem, and found that racial inequalities persisted even after taking these variables into account.

There are no official published data on the race of geriatric patients at each location. The Times obtained Medicare application data and supplemented it with Brown University data, which incorporates information from Medicaid and Medicare applications.

The analysis omitted states that have published limited information, and focused on the District of Columbia and 22 states where at least 20 percent of centers reported at least one case of coronavirus.

(c) The New York Times 2020

This article is a collaboration, with information from Robert Gebeloff, Danielle Ivory, Matt Richtel, Mitch Smith and Karen Yourish of The New York Times; Scott Dance of The Baltimore Sun; Jackie Fortiér and Elly Yu of KPCC / LAist; and Molly Parker of The Southern Illinoisan.

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Sam Conley

Sam Conley is new to online journalism but she is keen to learn. She is an MBA from a reputed university. She brings together relevant news pieces from various industries. She loves to share quick news updates. She is always in search of interesting news so that she can share them as well to Sunriseread's readers who could enjoy them with their morning coffee.

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