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Evidence for Action: Addressing Systemic Racism Across Long-Term Services and Supports.
Shippee, Tetyana Pylypiv; Fabius, Chanee D; Fashaw-Walters, Shekinah; Bowblis, John R; Nkimbeng, Manka; Bucy, Taylor I; Duan, Yinfei; Ng, Weiwen; Akosionu, Odichinma; Travers, Jasmine L.
Afiliación
  • Shippee TP; University of Minnesota School of Public Health, Minneapolis, MN, USA. Electronic address: tshippee@umn.edu.
  • Fabius CD; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
  • Fashaw-Walters S; University of Minnesota School of Public Health, Minneapolis, MN, USA.
  • Bowblis JR; Miami University, Farmer School of Business and Scripps Gerontology Center, Oxford, OH, USA.
  • Nkimbeng M; University of Minnesota School of Public Health, Minneapolis, MN, USA.
  • Bucy TI; University of Minnesota School of Public Health, Minneapolis, MN, USA.
  • Duan Y; University of Alberta Faculty of Nursing, Edmonton, AB, Canada.
  • Ng W; University of Minnesota School of Public Health, Minneapolis, MN, USA.
  • Akosionu O; University of Minnesota School of Public Health, Minneapolis, MN, USA.
  • Travers JL; New York University Rory Meyers College of Nursing, New York, NY, USA.
J Am Med Dir Assoc ; 23(2): 214-219, 2022 02.
Article en En | MEDLINE | ID: mdl-34958742
ABSTRACT
Long-term services and supports (LTSS), including care received at home and in residential settings such as nursing homes, are highly racially segregated; Black, Indigenous, and persons of color (BIPOC) users have less access to quality care and report poorer quality of life compared to their White counterparts. Systemic racism lies at the root of these disparities, manifesting via racially segregated care, low Medicaid reimbursement, and lack of livable wages for staff, along with other policies and processes that exacerbate disparities. We reviewed Medicaid reimbursement, pay-for-performance, public reporting of quality of care, and culture change in nursing homes and integrated home- and community-based service (HCBS) programs as possible mechanisms for addressing racial and ethnic disparities. We developed a set of recommendations for LTSS based on existing evidence, including (1) increase Medicaid and Medicare reimbursement rates, especially for providers serving high proportions of Medicaid-eligible and BIPOC older adults; (2) reconsider the design of pay-for-performance programs as they relate to providers who serve underserved groups; (3) include culturally sensitive measures, such as quality of life, in public reporting of quality of care, and develop and report health equity measures in outcomes of care for BIPOC individuals; (4) implement culture change so services are more person-centered and homelike, alongside improvements in staff wages and benefits in high-proportion BIPOC nursing homes; (5) expand access to Medicaid-waivered HCBS services; (6) adopt culturally appropriate HCBS practices, with special attention to family caregivers; (7) and increase promotion of integrated HCBS programs that can be targeted to BIPOC consumers, and implement models that value community health workers. Multipronged solutions may help diminish the role of systemic racism in existing racial disparities in LTSS, and these recommendations provide steps for action that are needed to reimagine how long-term care is delivered, especially for BIPOC populations.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 11_ODS3_cobertura_universal / 1_ASSA2030 Problema de salud: 11_financial_arrangements / 11_governance_arrangements / 1_desigualdade_iniquidade / 1_geracao_evidencia_conhecimento Asunto principal: Calidad de Vida / Servicios de Atención de Salud a Domicilio Tipo de estudio: Diagnostic_studies / Guideline Aspecto: Equity_inequality / Patient_preference Límite: Aged / Humans País/Región como asunto: America do norte Idioma: En Revista: J Am Med Dir Assoc Asunto de la revista: HISTORIA DA MEDICINA / MEDICINA Año: 2022 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 11_ODS3_cobertura_universal / 1_ASSA2030 Problema de salud: 11_financial_arrangements / 11_governance_arrangements / 1_desigualdade_iniquidade / 1_geracao_evidencia_conhecimento Asunto principal: Calidad de Vida / Servicios de Atención de Salud a Domicilio Tipo de estudio: Diagnostic_studies / Guideline Aspecto: Equity_inequality / Patient_preference Límite: Aged / Humans País/Región como asunto: America do norte Idioma: En Revista: J Am Med Dir Assoc Asunto de la revista: HISTORIA DA MEDICINA / MEDICINA Año: 2022 Tipo del documento: Article
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