Reflecting on injustices in LTC

In the last few weeks, mass protests against racism have led to wider recognition of racial injustices in our country, with alterations in policing procedures, removal of Confederate statues and a rethinking of corporate norms.

I’ve been reading about the systemic inequities in healthcare and reflecting on those in long-term care in particular. While I don’t have a prescription for correction, acknowledging problems can open the door to constructive discussions and creative solutions. As Deke Cateau stated in his guest column about diversity in LTC this week, “We must…have difficult and uncomfortable conversations that push us to change.”

This piece begins with racial disparities and describes other areas of unfairness I’ve noticed over the years. As the country reexamines long-held practices, perhaps LTC will reconsider its own policies, payment structures and assumptions.

  • One of the most obvious disparities in LTC is that those in management positions are more likely to be white and male, while over 90% of the nursing assistants are women1 and 59% of direct care workers are people of color.2LTC leadership is missing out on diverse voices and unique perspectives.
  • The average salary for a certified nursing aide is $27,9993 with 17% of CNAs living below the poverty level.4 This contributes to hiring challenges and understaffing, which leads to burnout, turnover and inadequate care. See this article for one potential remedial approach.
  • As noted in a 2019 LeadingAge report, there is insufficient funding for Medicaid patients, with most states having a reimbursement rate $16 per patient per day lower than the actual costs of care. According to this study in American Economic Review 2019, “moderate increases in Medicaid reimbursement rates lead to significant increases in the quality of care” primarily through an increase in the number of licensed practical and registered nurses.

For the entire article, visit: Reflecting on injustices in long-term care

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