Long-Stay Nursing Home Residents with Dementia: Telemedicine Mental Health Use during the COVID-19 Pandemic

Objective

To examine racial and ethnic differences in telemedicine mental health (tele-MH) use among nursing home (NH) long-stay residents with Alzheimer’s disease and related dementias (ADRD) during the pandemic.

Design

Observational study.

Setting and Participants

The 2020–2021 Minimum Data Set 3.0, Medicare datasets, and Nursing Home Compare data were linked. A total of 259,467 NH long-stay residents with ADRD and 14,159 NHs were included.

Methods

The outcome variable was the percentage of NH ADRD long-stayers who used tele-MH in 2021. The main independent variables were NH racial and ethnic compositions (ie, percentages of Black and Hispanic residents) and individual race and ethnicity. We conducted a set of logistic regression models with NH random effect. We first included only individual characteristics and then added NH characteristics.

Results

Approximately 7% and 35% of the study cohort had tele-MH use and MH use in 2021, respectively. In our study cohort, 13.7% were Black, 6.6% were Hispanic, and 79.7% were white residents. The mean age was 83.4. After adjusting for NH characteristics, we found residents in NHs with a high proportion of Hispanic residents were more likely to use tele-MH both compared with those in NHs with a low proportion [odds ratio (OR), 1.867; 95% CI, 1.566–2.226], whereas residents in NHs with a high proportion of Black residents were less likely to use tele-MH both compared with those in NHs with a low proportion (OR, 0.843; 95% CI, 0.928–0.997).

Conclusions and Implications

Telemedicine may offer an opportunity for NHs with a higher proportion of Hispanic residents to better address their needs for MH services. However, NHs with a higher proportion of Black residents may face challenges in telemedicine adoption. Future studies are needed to better understand factors that could impact tele-MH use in NHs and reasons that lead to racial and ethnic differences.