Differences in Timely Goals of Care Discussions in Nursing Homes Among Black Residents

Abstract

BackgroundIn the United States, disparities persist in end-of-life care outcomes between Black and White nursing home (NH) residents, particularly concerning infection-related management. Timely goals of care (TGOC) discussions are crucial for improving end-of-life outcomes but exhibit racial variations within NHs that are not well understood.ObjectivesExamine the association between the proportion of Black residents within NHs and TGOC discussion related to infection management.DesignA national analysis of palliative care survey data from NHs with the Minimum Dataset 3.0 and administrative data.Setting/Subjects892 NHs representing a weighted sample of 14,981 facilities.MeasurmentsTGOC discussions related to infection management were quantified using an index score from the palliative care survey (range: 0-18). Multivariable analyses assessed the association between the proportion of Black residents (≤2%, 2.1%–15%, >15%) and TGOC index scores.ResultsThe majority of NHs were for-profit, chain-affiliated, urban facilities with fewer than 100 beds, serving both Medicare and Medicaid beneficiaries. In stratified analyses, NHs with 2.1%–15% (−0.97 score; 95%CI -1.86, −0.07; P < .05) and 15% or more Black residents (−3.86 score; 95%CI -6.62, −1.10; P < .01) showed lower TGOC index scores compared to NHs with 2% or fewer Black residents in the West. NHs with 2.1%–15% Black residents had 1.29 lower TGOC index scores compared to NHs with 2% or fewer Black residents (95%CI -2.51, −0.07; P < .05) in the Northeast.ConclusionsTGOC discussions in US NHs are influenced by the proportion of Black residents, highlighting the need for targeted interventions to address regional disparities and improve end-of-life care equity.