Nursing homes with the highest proportion of Black residents have the greatest number of hospitalizations and emergency department visits, according to a new study led by researchers at NYU Rory Meyers College of Nursing.
Staffing levels likely drive the differences in hospitalizations and emergency department visits among nursing homes, the researchers report in the Journal of the American Geriatrics Society.
Studies show that nursing homes serving high proportions of Black residents may experience poor healthcare outcomes. To better understand nursing homes’ environmental and structural characteristics that may lead to these outcomes, the researchers examined data from 14,121 U.S. nursing homes using national datasets from 2019.
They found that, compared to nursing homes with no Black residents, nursing homes with at least 50% Black residents had lower ratios of registered nurse (RN) and certified nursing assistant (CNA) hours per resident per day and greater ratios of licensed practical nurse (LPN) hours per resident per day. As the proportion of Black residents in nursing homes increased, hospitalizations and emergency department visits also increased.
Nursing homes serving Black residents were also more likely to be located in urban settings, for-profit in the South, and have more Medicaid-funded residents.
“As lower use of RNs has generally been associated with increased emergency department visits and hospitalizations of nursing home residents, it is likely that the relative scarcity of skilled workers largely drove the differences in hospitalizations and emergency department visits in nursing homes with greater proportions of Black residents,” says Jasmine Travers, PhD, RN, assistant professor at NYU Rory Meyers College of Nursing and the study’s lead author.
“Staffing is a modifiable area in which federal and state agencies should take action to eliminate disparities in quality of care among nursing homes,” adds Travers.
Dean Amar is an accomplished leader, advanced practice psychiatric nurse, and researcher studying sexual and dating violence. She joins NYU from the University of Nevada, Las Vegas (UNLV) School of Nursing, where she has been dean and a tenured professor since 2018.
NYU Welcomes Dean Amar
“Angela Amar comes to NYU’s Rory Meyers College of Nursing with an outstanding reputation as a researcher, a nursing educator, and an advocate for the profession. She particularly impressed us with her distinguished record of leadership, not only at UNLV but also at Emory and Boston College, and especially her focus on advancing diversity and inclusion in the profession, her concentration on student success, and her attention to faculty development, “ says NYU President Andrew Hamilton. “We were struck, too, by how strategically she was able to transform her vision, ambitions, and goals for UNLV’s School of Nursing into reality, with improvements in research funding, publications, student success, and faculty hiring.”
Before her tenure as dean of the UNLV School of Nursing, Dean Amar joined the faculty of Emory University’s Nell Hodgson Woodruff School of Nursing in 2012, where she served as an assistant and then associate dean between 2013 and 2017. She developed forensic nursing programs for Emory, Boston College, and Georgetown, establishing a nationwide educational model on forensic nursing for nursing schools. Dean Amar’s scholarship on sexual and partner violence focuses on improving care and support for survivors of violence and trauma when they enter the healthcare system.
Dean Amar is a widely published author. Her books, articles, and book chapters include A Practical Guide to Forensic Nursing (2015, Sigma Theta Tau International Honor Society of Nursing; with Sekula); “Gender Violence Prevention in Middle School Male Athletics Programs” (2020, JAMA Pediatrics, with Laughon); “Bullying Prevention: a Summary of the Report of the National Academies of Sciences, Engineering, and Medicine” (2016, with others); “Administrators’ perceptions of college campus protocols, response, and student prevention efforts for sexual assault” (2014, Violence and Victims; with others); and “Gender Differences in Attitudes and Beliefs Associated With Bystander Behavior and Sexual Assault” (2014, Journal of Forensic Nursing; with others). She is the recipient of numerous honors and awards, including receiving the 2022 Nursing Leader Award from the Asian American Group and Las Vegas India Chamber of Commerce; being selected for the American Association of Colleges of Nursing Wharton Executive Leadership program; and receiving the 2017 Lillian Sholtis Brunner Award for Innovative Practice in Nursing, Alumni Award, from the University of Pennsylvania’s School of Nursing. She is a fellow of the American Academy of Nursing, a Distinguished Fellow of the International Association of Forensic Nurses, and a Fellow of the National League for Nursing’s Academy of Nursing Education.
She earned her BSN (1987) and MN (1992) from the Louisiana State University Medical Center’s School of Nursing and her PhD from the University of Pennsylvania (2003), and is licensed as an RN in several states, is a board-certified advanced forensic nurse, and is certified as an adult psychiatric and mental health advanced practice nurse.
A recent study in the International Journal of Nursing Studies shows a direct correlation between a patient’s language preference and the risk of being readmitted to the hospital from a home health care environment.
“Part of the issue with readmission is that it is always complicated,” says Allison Squires, PhD, RN, FAAN, associate professor at NYU Rory Meyers College of Nursing and the study’s lead author. Often, the outcome comes down to how well the language barrier was handled in a healthcare encounter, she says. If the patient has complex health issues or is sent home too early, language barriers will only make things more difficult.
When patients don’t have a needed interpreter, they likely won’t have a good enough explanation of services. “First and foremost, is there proper implementation by language services,” says Squires. Nurses must also be given the proper time to work with a patient, especially if extra time is needed for an interpreter’s services. “If you have to be in the hospital these days, you have to be pretty sick in general,” she says. “A language barrier makes it even trickier.”
Squires says that while many in the medical community have known about this problem for a long time, this is the first study to actually show the direct link. The best way to help take steps to lessen this effect is for healthcare workers to ensure a patient’s language preference is accurate and listed in the medical records and that interpreter’s services are available.
For instance, if a patient visits a primary care physician and speaks a little English, they might be listed as an English speaker, even if they don’t speak it well. Without the accurate language preference on record, it might look like the patient doesn’t need an interpreter when in fact they do, says Squires.
Attentive nurses can change that when they first encounter a patient (although in an emergency situation, that might not be possible) so they can record the patient’s language preference with accuracy. They can also document every time an interpreter is used–whether by phone, video or in person. It’s important to also note when an interpreter was expected but didn’t show up when they were supposed to. This isn’t to get anyone in trouble, but shows that a discharge might have been delayed because of that and nurses didn’t want to rush the process.
The potential for language misunderstandings is profound. Patients could have difficulty communicating when they are hungry or in pain or even if they need to use the bathroom. A patchwork of hand gestures is also difficult to interpret and could open the door for some serious cultural miscommunication, says Squires.
And the stopgap method of pulling in a nurse who speaks the patient’s language isn’t the best practice. The nurse might speak the language, but that doesn’t mean they can read or write it fluently enough to give the patient accurate medical information. And the practice isn’t helpful for the patient’s transition to home care.
Healthcare organizations are moving to correct this issue, says Squires, and it takes a comprehensive effort. Sending care instructions home in the patient’s language and in their caregiver’s (both a home health care provider and a family member) language is necessary to prevent any mix ups. And ensuring the patient has access to an interpreter or a care provider who speaks the same language is important for accurate care and for positive outcomes.
Although Squires says the study’s findings weren’t unexpected, there was a finding that surprised her. “Russian speaking patients have the second-highest risk for readmission,” she says, blasting the stereotype that only people of color speak a different language and need interpreters. The more it is recognized and mitigated, that patient is less likely to return to the hospital with an often-preventable readmission. “A language barrier is a language barrier,” Squires notes, “and it ups your risk of readmission.”
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