“Older African Americans are less likely to use nursing homes than similar whites, with lower institutionalization replaced by a higher use of paid home care, informal-only care, and no care…Persistent effects of race/ethnicity could be the result of culture, class, and/or discrimination that may impair equitable access of services.”

“Data came from the 1987 National Medical Care Expenditure Survey which oversampled disabled persons living in the community and sampled persons living in nursing homes. The survey included 5886 persons age 65 and older living in the community, including 1148 with functional impairments and 4995 in nursing homes. The sample size of non-Latino whites was 8363, the sample of African Americans was 957, and the sample of Latinos was 291.”

“Race is an independent predictor for nursing home care for older African Americans when the reference category is no care. Older African Americans are less likely to use nursing home care compared to similar non-Latino whites (compared to no care) and are more likely to use paid home care, unpaid-only home care, and no care (in comparison to nursing home care).”

“Why is race a significant independent variable, and does community-based long-term care compensate equitably for lower nursing home use? Explanations include: culture, class, race effects from institutionalized discrimination, independent race effects from unmeasured noneconomic effects, that correlate with race, and geographic clustering nationally of older minorities…These findings indicate that any expansion of community-based long-term care needs to take into account older minorities’ patterns of needs and potential access barriers.”