IV. The Continuation of Racial Segregation and Discrimination in Nursing Homes

      In 2000, nursing homes provided care to 1.5 million elderly and disabled persons, and by 2050 nursing homes are projected to provide care to 6.6 million elderly and disabled persons. Between 2000 and 2030, the elderly African American population will grow by 168%, while the elderly population of Whites will grow by only 90%. Traditionally, elderly African Americans need more access to long-term care services to fulfill their daily activities, such as showering, toileting, and eating. Elderly African Americans' access to health care services is severely restricted compared to their White counterparts, regardless of socioeconomic status and health insurance.

      Studies show that elderly African Americans are among the most vulnerable members of society because of their lack of access to health care services. Elderly African Americans are less likely to receive breast cancer screening, eye examinations for patients with diabetes, beta-blocker medication after heart attack, and follow-up treatment after hospitalization for mental illness. The lack of access to health care services directly affects the health care status of elderly African Americans, causing them to over use services to care for untreated conditions, evidenced by a study of Medicare usage. For *455 example, elderly African Americans have higher rates of pulmonary disease [hypertension], diabetes, circulatory problems, and arthritis than Whites. Even though African Americans have higher rates of diabetes, they have less access to leg-sparing surgery than leg amputation surgery.

      Under Medicare, the only health services elderly African Americans have greater access to than Whites are for services to care for untreated conditions, such as amputations from diabetes, removal of testes from prostate cancer, removal of tissue from late stage pressure sores, and implantation of shunts for renal disease. African Americans have greater access to these services than Whites even though the number of African Americans suffering from these ailments is less than the number of Whites. Therefore, it is imperative that elderly African Americans be granted equal access to quality long-term care services. Government studies have shown that elderly African Americans “use nursing homes 20 percent less than aged Whites, with the gap growing to 40 percent among those aged 85 and over.”

      Based on the abovementioned data, it is clear that racial inequities remain ubiquitous in the long term care system. There have been a number of “neutral” reasons suggested for these racial inequities, such as cultural differences, geographic racial segregation, and socioeconomic status. All of these factors play a role in the continuation of these racial inequities; however, empirical data and government reports suggest that racial discrimination remains the central reason for these inequities. Research shows that racial inequities continue when these “neutral” factors are controlled, which only racial discrimination, however defined, *456 explains. A review of the nursing home system serves as an example of the ills of the entire health care system. Scholars note that nursing homes remain more racially segregated than hospitals, and illustrate that racial discrimination continues to prevent African Americans from accessing quality health care service regardless of socioeconomic status, education, or health insurance status. The discrimination is institutionalized and accomplished through delaying transfer and denial of admission of elderly African Americans to quality nursing homes.

      During the first research studies of nursing home quality in the 1980s, researchers found that African Americans received unequal quality as a result of transfer delays and admission to poor quality nursing homes. Studies show that African Americans were delayed transfer to quality nursing homes because of their race. The inequities caused by transfer delays are further exacerbated by racial discrimination in nursing home admission policies. Even when payment status is controlled, there is a disparity in the number of African Americans admitted to quality nursing homes compared to the number of Whites admitted to the same nursing homes.

      Once African Americans gain admission to a nursing home, their physical condition is further compromised by the poor quality of care provided. The number of Medicare deficiencies was two times higher in predominately African American nursing homes versus predominately White nursing homes. These inequities in quality are found not only in the difference in quality of nursing homes to which African Americans are admitted versus the nursing homes to which Whites are admitted, but also in the differences in the quality of care received when they reside in the same nursing home. National studies show that African American “nursing home residents are less likely to receive medically appropriate treatments, ranging from cardiovascular disease medication to pain medication to *457 antidiabetes drugs” than Whites residing in the same nursing home.

      The continuation of these racial inequities in the quality of nursing home care, which are not explained by geographical racial segregation or socioeconomic status, shows that the government has not fulfilled its promise to end racial discrimination in the health care system. The failure of the United States to put an end to these racially discriminatory health care practices that violate Title VI suggests that the prohibitions against racial discrimination in Title VI are more illusionary than real.