aals 2006 racial dis

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Published on January 14, 2008

Author: Vincenza

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Striving For Equal Access and Quality, But Settling For the Status Quo: Is Title VI More Illusory Than Real?* :  Striving For Equal Access and Quality, But Settling For the Status Quo: Is Title VI More Illusory Than Real?* Ruqaiijah Yearby, J.D., M.P.H. Assistant Professor, Institute for Health Law Loyola University Chicago School of Law *This is a summary of a forthcoming article in the DePaul Journal of Health Care Law. You may send any questions or comments to ryearby@luc.edu. A Tale of Two Patients:  A Tale of Two Patients Kelley Mitchell and Blanche Manning are 75-year-old women, living alone in an affluent neighborhood called Terrell Park. One day, both women suffer hip fractures and are rushed to the neighborhood hospital. Each woman recuperates, but is unable to care for herself at home. Thus, the hospital discharge staff transfers both Kelley and Blanche to nursing homes. Slide3:  Seeking to transfer Kelley, a hospital discharge nurse contacts the sole nursing home in Terrell Park, giving Kelley’s information and requesting a transfer. The request is rejected. Ten minutes later, the same nurse contacts the same nursing home on behalf of Blanche, giving her information and requesting a transfer. The nursing home accepts Blanche. Slide4:  Blanche is transferred to this high-quality nursing home, while Kelley is transferred to a poor quality nursing home located fifty miles from her home. The quality of care provided at Blanche’s nursing home is like a resort, while Kelley’s nursing home is substandard. Both nursing homes were recently surveyed for compliance with the Medicare and Medicaid participation regulations. Slide5:  Blanche’s nursing home did not have any violations, whereas Kelley’s nursing home had several violations including its failure to prevent bedsores and offer adequate pain management. Even though their payment status, physical condition, neighborhood of residency, and educational level are the same, Kelley and Blanche are placed in significantly different nursing homes. The only difference is their race. Blanche is White and Kelley is African-American. Introduction:  Introduction Two decades of empirical data show that the story of these two women, Blanche and Kelley, is a common occurrence. Many legal and medical experts,* assert that the most likely explanation for Kelley’s lack of access to quality nursing home care is racial discrimination. Thus, one must ask whether the protections offered by Title VI, such as equal access and quality regardless of race, are more illusory than real in the health care industry. *Vincent Mor, et al, Driven to Tiers: Socioeconomic and Racial Disparities in the Quality of Nursing Home Care, 82 Milbank Quarterly 227, 237 (2004); David Grabowski, The Admission of Blacks to High-Deficiency Nursing Homes, 42 Med Care 456, 458 (2004); Mary Fennell, et al., Facility Effects in Racial Differences in Nursing Home Quality of Care, 15 Am. J. of Med. Quality 174, 174-176 (2000); David Falcone and Robert Broyles, Access to Long Term Care: Race as a Barrier, 19 J. Health Pol. Pol’y & L. 583, 588-592 (1994); Sidney Watson, Health Care in the Inner City: Asking the Right Question, N.C. L. Rev. 1647, footnote 103 (1993). Road Map:  Road Map The Promise of Equality: Government Legislation in the 1960s Continuation of Racial Discrimination: Denial of Equal Access and Quality in Nursing Homes More Illusory than Real: Government Protection Against Racial Discrimination Finding a Solution Conclusion The Promise of Equality: Government Legislation in the 1960s:  The Promise of Equality: Government Legislation in the 1960s Title VI of the Civil Rights Act of 1964 : Prohibits racial discrimination by health care entities receiving federal funding and requires the government to take all necessary measures to prevent this discrimination The Medicare and Medicaid Acts: Nursing homes eligible for Medicare and/or Medicaid funding have to certify that they no longer discriminate based on race Continuation of Racial Discrimination: Denial of Equal Access and Quality in Nursing Homes:  Continuation of Racial Discrimination: Denial of Equal Access and Quality in Nursing Homes Even when payment status is controlled, there is a disparity in the number of African-Americans admitted to high quality nursing homes compared to the number of whites admitted to the same nursing homes* Barred from admission from quality nursing homes, African-Americans are admitted to predominately Medicaid nursing homes, which traditionally provide poor quality of care *David Grabowski, The Admission of Blacks to High-Deficiency Nursing Homes, 42 Med Care 456, 458 (2004) . Continuation of Racial Discrimination: Denial of Equal Access and Quality in Nursing Homes (cont.):  Continuation of Racial Discrimination: Denial of Equal Access and Quality in Nursing Homes (cont.) Researchers found that African-Americans reside in nursing homes with more violations of Medicare participation regulations than Whites* Empirical data from a Chicago Study shows that there is a correlation between race and poor quality in nursing homes *Vincent Mor, et al, Driven to Tiers: Socioeconomic and Racial Disparities in the Quality of Nursing Home Care, 82 Milbank Quarterly 227, 237 (2004); David Grabowski, The Admission of Blacks to High-Deficiency Nursing Homes, 42 Med Care 456, 458 (2004) ; Mary Fennell, et al., Facility Effects in Racial Differences in Nursing Home Quality of Care, 15 Am. J. of Med. Quality 174, 174-176 (2000). The Chicago Study*:  The Chicago Study* Examined sample of Chicago nursing homes with a high concentration of African-Americans, Whites, or a mixture of all races Compared the number of violations of Medicare participation regulations in each nursing home Results shown in Graph III show a significant correlation between the percent of African-American residents and number of violations of the Medicare participation regulations *Study entitled, “Assessing Racial Disparities in the Quality of Nursing Home Care,” and conducted by: Ruqaiijah Yearby, Alexandra Pae Song, Margaret Eaglin, Claire Dobbins, Elissa J. Bassler, Margaret Beaman. Graph III: Number of Violations by Racial Characteristics :  Graph III: Number of Violations by Racial Characteristics Black White Mixed Predominant Race 0 1 2 3 4 5 Mean complaints Number of violations More Illusory than Real: Government Protection Against Racial Discrimination:  More Illusory than Real: Government Protection Against Racial Discrimination A 1993 U.S. Commission on Civil Rights Report on Title VI enforcement found that the government allowed racial discrimination to continue without federal intervention and routinely conducted superficial and inadequate investigations. In 1993, ten of the twenty-one complaints filed resulted in findings of noncompliance of the requirements of Title VI. Every complaint was resolved through voluntary agreements, but the discriminatory practices still continue. More Illusory than Real: Government Protection Against Racial Discrimination (cont.):  More Illusory than Real: Government Protection Against Racial Discrimination (cont.) In Alexander v. Sandoval, the Supreme Court ruled that only the government has the right to resolve disparate impact discrimination claims under Title VI. Forty-one years after the enactment of Title VI, the government has never filed a federal action or initiated any administrative proceedings for racial discrimination in health care. Finding A Solution:  Finding A Solution File a claim under: Medicaid The International Convention on the Elimination of All Forms of Racial Discrimination Work to revise Title VI standards: Apply housing standards of racial discrimination to health care Request Congressional Study of the Problem Conclusion :  Conclusion To make Title VI more than illusory, the federal government needs to acknowledge the problem of racial discrimination in health care by codifying penalties for segregation, citing nursing homes for failing to provide equal access and quality to African-Americans, and aggressively terminating facilities that fail to do so.

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