Trends in family ratings of experience with care and racial disparities among Maryland nursing homes

Abstract

Background: Providing equitable and patient-centered care is critical to ensuring high quality of care. Although racial/ethnic disparities in quality are widely reported for nursing facilities, it is unknown whether disparities exist in consumer experiences with care and how public reporting of consumer experiences affects facility performance and potential racial disparities.

Methods: We analyzed trends of consumer ratings publicly reported for Maryland nursing homes during 2007-2010, and determined whether racial/ethnic disparities in experiences with care changed during this period. Multivariate longitudinal regression models controlled for important facility and county characteristics and tested changes overall and by facility groups (defined based on concentrations of black residents). Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food and meals; physical environment; and autonomy and personal rights.

Results: Overall ratings on care experience remained relatively high (mean=8.3 on a 1-10 scale) during 2007-2010. Ninety percent of survey respondents each year would recommend the facility to someone who needs nursing home care. Ratings on individual domains of care improved among all nursing homes in Maryland (P<0.01), except for food and meals (P=0.827 for trend). However, site-of-care disparities existed in each year for overall ratings, recommendation rate, and ratings on all domains of care (P<0.01 in all cases), with facilities more predominated by black residents having lower scores; such disparities persisted over time (P>0.2 for trends in disparities).

Conclusions: Although Maryland nursing homes showed maintained or improved consumer ratings during the first 4 years of public reporting, gaps persisted between facilities with high versus low concentrations of minority residents.

Figure 1

Overall satisfaction, recommendation of the nursing home, and family experience ratings of individual domains of care by percentages of black residents in the nursing home, 2007–2010. Note: the possible ranges are 1–10 for overall satisfaction, 0–100 percent for recommendation of the nursing home, and 1–4 for family experiences with individual domains of care. In all cases higher score indicates better reported experience. The domain for staff & administration reflects family evaluations of staff and administrator responses to questions, and whether they treat residents and family members with courtesy and respect; the domain for care provided reflects family evaluations of the actual care provided to residents, responses of nursing homes to family concerns about care provided, and family participation in care planning; the domain for food & meals reflects family evaluations of staff availability to help with eating and drinking of residents; the domain for physical aspects reflects family evaluations of the cleanness and quietness of the facility and rooms; and the domain for autonomy & personal rights reflects family evaluations of respect for resident privacy and availability of private space for family visits.

Figure 1

Overall satisfaction, recommendation of the nursing home, and family experience ratings of individual domains of care by percentages of black residents in the nursing home, 2007–2010. Note: the possible ranges are 1–10 for overall satisfaction, 0–100 percent for recommendation of the nursing home, and 1–4 for family experiences with individual domains of care. In all cases higher score indicates better reported experience. The domain for staff & administration reflects family evaluations of staff and administrator responses to questions, and whether they treat residents and family members with courtesy and respect; the domain for care provided reflects family evaluations of the actual care provided to residents, responses of nursing homes to family concerns about care provided, and family participation in care planning; the domain for food & meals reflects family evaluations of staff availability to help with eating and drinking of residents; the domain for physical aspects reflects family evaluations of the cleanness and quietness of the facility and rooms; and the domain for autonomy & personal rights reflects family evaluations of respect for resident privacy and availability of private space for family visits.