IV. African Americans Can't Get out of the System: Poor Health Status of Elderly African Americans

Ruqaiijah Yearby, African Americans Can't Win, Break Even, or Get out of the System: The Persistence of “Unequal Treatment” in Nursing Home Care, 82 Temple Law Review 1177 (Spring-Summer 2010) (214 Footnotes).


Between 2000 and 2030, the elderly African American population is projected to grow by 168%, while the elderly population of Caucasians is expected to grow by 90%.   Although African Americans receive poor-quality care compared to Caucasians, African Americans are forced to continue to reside in nursing homes for several reasons.

First, many Caucasians no longer reside in nursing homes in part because of the creation of new long-term care service providers. Studies show that “an explosive expansion of private-pay assisted-living developments in the 1990s, which served predominantly Caucasian and relatively affluent clientele,” decreased the number of Caucasians living in nursing homes.   The siphoning off of Caucasians has created an excess nursing home capacity so that nursing homes are filled with African American patients.  

Second, “[e]ven after adjusting for income differences, the burden of disability falls heaviest on elderly minorities.”   Born and raised during the Jim Crow era of legalized racial discrimination, elderly African Americans lacked equal access to health care services for most of their lives, and thus are more disabled than their white counterparts.  

Research indicates that relative to Caucasians, elderly African Americans have higher rates of hypertension.   In fact, elderly African Americans are more disabled than Caucasians and have the fewest years of active life remaining.   These results are at every age among the elderly beginning at sixty years old.   Consequently, elderly African Americans need more access to nursing home services to fulfill their daily *1191 activities, such as showering, toileting, and eating.   Nevertheless, the data shows that African Americans receive fewer services than Caucasians.   Thus, African Americans cannot get out of the system because elderly African Americans' health status is compromised, making them more disabled and reliant on nursing home care.

Three decades of empirical data show that African Americans remain limited by their race as they try to access quality nursing home care.   But how can this be the case in a post-racial era? I discuss the reasons for the continuation of racial disparities in the provision of quality nursing home care in the next section.