08 Nov

Posted at 12:42h in Blog

[vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column][vc_column_text] A Looming Shortage Of Geriatricians Will Severely Affect Our Aging Adults My younger son and his wife recently blessed us with a baby girl. She is a beautiful little 4-month-old, healthy, and gorgeous little girl. Recently, I asked my son for permission to tag along for her monthly pediatric visit. My purpose was to see the difference in how children and adults receive health care. When we arrived for our appointment at the local hospital pediatrics clinic, we were welcomed by a fantastic bunch of friendly and knowledgeable professionals: doctors, nurses, paraprofessionals, educators, and support staff. I was overwhelmed with a sense of deep caring and professionalism. It was all very organized and smooth. It was a great experience, and while I was thrilled that my granddaughter was receiving such top-notch care and was healthy, my heart sank because hundreds of thousands of aged adults can't avail themselves of the same quality experience. There is a severe shortage of geriatricians in the United States. We only have 7,000 geriatricians for an over-65 population of 54 million. Experts suggest that we need at least 40,000. In contrast, we have over 50,000 pediatricians for 74 million children. Geriatrics is one of the few medical specialties in the United States that is contracting even as the need increases, ranking at the bottom of the list of specialties that internal medicine residents choose to pursue. The United States is facing a shortage of geriatricians as the number of older adults outpaces the number of newly trained specialists in the field. A geriatrician is a physician already certified in internal or family medicine who has completed additional training in caring for older adults. In addition to providing clinical care, geriatricians are skilled in navigating the labyrinth of psychological and social problems that often arise in the aging population. These doctors understand the dynamics of an older person's body. They can prescribe treatment methods with the best outcomes for this population segment. The scarcity of geriatricians in the United States (especially in rural areas) is a severe problem in the public health sphere due to the increased number of older adults and the lack of healthcare professionals who specialize in this demographic. Approximately 7000 geriatricians practice in the United States, and around half are full-time. Research shows that 30 percent of people 65 years old and older need care from a geriatrician, and each geriatrician can care for up to 700 patients. The issue of aging is more critical in rural areas because residents tend to be older, on average, than those in urban areas. In 2020, one-third of all adults 65 and older lived in rural areas. With only 7,000 geriatricians in the U.S., we have only roughly 1.07 geriatricians for every 10,000 geriatric patients. To put this into perspective, the American Geriatrics Society estimates that one geriatrician can care for about 700 patients. This deficit is striking and will have many implications for the senior population in the future. Experts suggest that we need at least...

14 Feb

Posted at 17:02h in Blog

[vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column css=".vc_custom_1621365636104{padding-top: 10px !important;}"][vc_empty_space height="25px"][vc_column_text]It’s Time: Repeal the 3-Day Inpatient Hospital Requirement for Medicare Skilled Nursing Facility Coverage Last year, the Center for Medicare Advocacy suggested that it was time to repeal the three-day inpatient hospital requirement that is necessary for Part A coverage in the traditional Medicare program. The recent Second Circuit decision in Barrows v. Becerra, which holds that Medicare beneficiaries have a Constitutional right to appeal when their status is changed from inpatient to observation, has renewed focus on the statutory three-day stay requirement. When Medicare was enacted in 1965, it limited coverage in a skilled nursing facility (SNF) under Part A to beneficiaries who had been inpatients in an acute care hospital for at least three consecutive days before their discharge to a SNF. The benefit, called extended care, was viewed, literally, as a limited extension of a hospital stay. Since the average length of stay in an acute care hospital for a patient aged 65 or older in 1965 was more than 13 days, most hospitalized Medicare beneficiaries had no difficulty satisfying the three-day inpatient requirement. Times have changed. Congress should repeal the three-day inpatient requirement for multiple reasons.[/vc_column_text][vc_empty_space height="25px"][/vc_column][/vc_row][vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column][vc_column_text] Medical care has changed in the past 55 years. [/vc_column_text][vc_column_text]Many medical procedures, including surgeries, that required inpatient hospital stays for multiple days or weeks in 1965 now require limited hospital stays or may even be done on an outpatient basis. Following these procedures, patients may nevertheless need the skilled nursing or skilled rehabilitation services that a SNF provides. As the Centers for Medicare & Medicaid Services (CMS) acknowledged in 2014, in proposed rules for Accountable Care Organizations (ACOs). Repealing the three-day inpatient hospital requirement reflects the realities of modern medicine.[/vc_column_text][vc_empty_space height="25"][/vc_column][/vc_row][vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column][vc_column_text] Traditional Medicare and Medicare Advantage need to be aligned. [/vc_column_text][vc_column_text]While the traditional Medicare program retains the three-day requirement, Medicare Advantage (MA) plans are permitted by law to waive the three-day requirement, and most do. At present, approximately 42 percent of Medicare beneficiaries receive their health care through MA plans, either because MA is the only option offered by their former employers or unions as retiree health or because they choose MA. More than 60 percent of all Medicare beneficiaries receive coverage through programs that generally waive the three-day requirement. All Medicare beneficiaries should receive comparable care and services, regardless of how they participate in Medicare.[/vc_column_text][vc_empty_space height="25"][/vc_column][/vc_row][vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column][vc_column_text] Observation status in hospitals deprives beneficiaries of Medicare SNF benefits and necessary care. [/vc_column_text][vc_column_text]Over the last 20 years, under pressure from CMS, acute care hospitals have increasingly described patients as receiving care in observation stays, covered by Medicare Part B rather than by Part A. What CMS labels “observation services” are provided to patients in “outpatient” status, which does not qualify patients for Part A SNF coverage, even though the care and services that observation patients receive may be indistinguishable from the care and services received by inpatients and even when...

21 Dec

Posted at 19:56h in Blog

[vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column css=".vc_custom_1621365636104{padding-top: 10px !important;}"][vc_empty_space height="25px"][vc_column_text]The Joy of brightening other lives, bearing each other’s burdens, easing each other’s loads and supplanting empty hearts and lives with generous gifts becomes for us the magic of the holidays[/vc_column_text][vc_empty_space height="25px"][vc_column_text]My Elder wishes all our families and friends a wonderful and healthy holiday and a Happy New Year. A new year is another chance for us to get it right. Warmest wishes, Jack Halpern Claudine Halpern[/vc_column_text][vc_empty_space height="25px"][/vc_column][/vc_row]...

18 Nov

Posted at 18:11h in Blog

[vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column css=".vc_custom_1621365636104{padding-top: 10px !important;}"][vc_empty_space height="25px"][vc_column_text] Medicare Advantage Plans: Advantage? Really? [/vc_column_text][vc_column_text css=".vc_custom_1637259675368{padding-top: 20px !important;padding-right: 20px !important;padding-bottom: 20px !important;padding-left: 20px !important;background-color: #fafafa !important;}"]advantage [ ad-van-tij,] Noun Any state, circumstance, opportunity, or means especially favorable to success, interest, or any desired end: Benefit; gain; profit; superiority or ascendancy (often followed by over or of):[/vc_column_text][vc_empty_space height="25px"][vc_column_text] ‘Tis the season of Medicare open enrollment. Odds are, you've seen those Medicare Advantage TV commercials featuring the likes of William Shatner, George Foreman, Jimmie Walker and Joe Namath touting the "free" health insurance plans offering enticing benefits not available from so-called "Original Medicare" (also called "traditional Medicare"). But are they for real? As an elder advocate for the last 48 years, I have experienced many government programs for the elderly. The most egregious program in my opinion is The Medicare Advantage Plan. Through television, social media, newspapers and mailings, tens of millions of Medicare beneficiaries are being inundated — as they are each autumn during the open enrollment period — by marketing from Medicare Advantage plans touting low costs and benefits not found with traditional Medicare. Dental, vision and hearing coverage are among the most advertised benefits. While people in traditional Medicare paid on average about $992 for dental care in 2020, those in Medicare Advantage plans paid $766, according to the study. For vision, people with traditional Medicare paid $242, compared with $194 for those covered by a Medicare Advantage plan.[/vc_column_text][vc_empty_space height="25px"][vc_column_text]A client of mine recently related this story to me. [blockquote text="“Although Mom saw her MA premiums increase significantly over the years, she didn’t have any real motivation to disenroll until after she broke her hip and required skilled care in a nursing facility. After a few days, the nursing home administrator told her that if she stayed there, she would have to pay for everything out of her own pocket. Why? Because a utilization review nurse at her MA plan, who had never seen or examined her, decided that the care she was receiving was no longer ‘medically necessary.’ Because there are no commonly used criteria as to what constitutes medical necessity, insurers have wide discretion in determining what they will pay for and when they will stop paying for services like skilled nursing care by decreeing it ‘custodial.”1" text_color="" width="" line_height="undefined" background_color="" border_color="" show_quote_icon="yes" quote_icon_color="#fafafa"][/vc_column_text][vc_empty_space height="25px"][vc_column_text]A Medicare Advantage Plan, also called a Part C or an MA Plan, may sound enticing. It combines Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and usually Medicare Part D (prescription drug coverage) into one plan. These plans cover all Medicare services, and some offer extra coverage for vision, hearing, and dental. They are offered by private companies approved by Medicare. Still, while many offer $0 premiums, the devil is in the details. You will find that most have unexpected out-of-pocket expenses when you get sick, and what they pay can differ depending upon your overall health. While a MA plan might sound like a good idea when you are younger and healthier, as you age and get sicker,...

27 Sep

Posted at 20:28h in Blog

[vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column css=".vc_custom_1621365636104{padding-top: 10px !important;}"][vc_empty_space height="25px"][vc_column_text]A disturbing trend is becoming increasingly evident across the country: The eviction of vulnerable nursing home residents from their facilities, often without notice, preparation, or a safe and appropriate place to go. Consider the following 2 cases reported by long-term care ombudsmen: After raising concerns about an increase in the price of sodas in the nursing facility machines, and then asking a physician assistant who came to see him to leave his room, Mr. T was forcibly removed from his nursing home and discharged. He appealed the discharge and won but the nursing home refused to follow the hearing officer’s order to permit him to return. At the new nursing home where he was sent, he became increasingly distressed, depressed, anguished, and anxious. He worried that he would never be able to return to his former nursing home. Mr. R received a notice of discharge, but the facility failed to notify his sister, who had power of attorney, the ombudsman, the Department of Health, or the appeals officer as required by state and federal regulations. The nursing home social worker drove him to a motel and booked a room for him for three nights only, after which he was to check out. The resident had no money, no medication, no phone, and no one to help him transfer to/from his chair -- assistance he needed since one of his legs had been amputated. Residents receiving Medicare rehabilitation in facilities belonging to one particular corporation were unexpectedly discharged when Medicare coverage ended. They were not given the option of remaining in the facilities and paying privately or through Medicaid if they still needed nursing home level of care. Shockingly, these residents were discharged to homeless shelters, storage units (in the middle of summer heat), unlicensed boarding homes where they reported they were assaulted and/or robbed, and even driven to and left in other cities.[/vc_column_text][vc_empty_space height="25px"][vc_column_text]Under federal law and regulation, there are only six permissible reasons for the transfer or discharge of a resident: 1. The resident’s welfare and needs cannot be met in the facility 2. The residents’ health has improved sufficiently so the resident no longer needs the services provided by the facility 3. The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident 4. The health of individuals in the facility is endangered 5. The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility 6. The facility ceases to operate.[/vc_column_text][vc_empty_space height="25px"][vc_column_text]Regulations also mandate that residents be given written notice within certain time frames, have the right to appeal, and must be discharged in a safe and orderly way to a location that can meet their needs. Anita Willis says the social worker offered her a painful choice: She could either leave the San Jose, Calif., nursing home where she’d spent a month recovering from a stroke — or come up with $336 a day to...

30 Aug

Posted at 16:09h in Blog

[vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column css=".vc_custom_1621365636104{padding-top: 10px !important;}"][vc_empty_space height="25px"][vc_column_text]When it comes to the typical American caregiver, most may envision a sweet, motherly, nurturing woman. They’d be surprised, then, to learn that 40 percent of America’s family caregivers are actually men. There are 16 million male caregivers in America, making up 2 of every 5 caregivers, according to a new groundbreaking study by AARP. Historically, women have been expected to serve as primary providers of “caretaking” work, whether it’s parenting or caring for an aging family member or paid work in positions typically associated with women such as child-care providers, nurses, or health aide. Alternatively, men are often expected to be the primary breadwinners and play less of a role in the emotional or physical caretaking of a family. And men in caregiving professions that are most often fulfilled by women (e.g., nursing, childcare) are often seen as the exception. While the role of women as caregivers may have been true for much of history, gender roles and intergenerational dynamics are shifting and as Ai-jen Poo, director of Caring Across Generations, notes ‘continuing to associate caregiving with one gender does more harm than good.’ The problem lies not only in the fact that males are often overlooked as caregivers within families, but that they seek support more rarely than their female counterparts. Many men prefer to solve problems on their own rather than ask for help, but it is important for male caregivers to get comfortable with seeking assistance. There are many social, health and human services available in the community that can be beneficial for both caregivers and care recipients alike. This could be in part due to cultural stereotypes of a man’s need to exude strength and independence, but it could also be because many male caregivers don’t even see themselves as caregivers at all — rather as sons, spouses and friends simply helping a loved one in need.[/vc_column_text][vc_empty_space height="25px"][vc_column_text] Statistics: [/vc_column_text][unordered_list style="circle" animate="no"] 9% of men felt they had no choice in taking on their role as caregivers. This number rose to 60% when it came to caring for a partner or spouse. 62% found it necessary to assist with personal care and secondary tasks, and 54% found it difficult to help with more intimate responsibilities 56% of caregivers assisted with medical and nursing duties (75% for those caring for a spouse). 47% helped give medication or injections, but 72% reported having no prior training. 63% of male caregivers report being the primary caregiver. Of this percentage, some had additional help, but 78% received no outside support. The average age of male caregivers is 26.9, although the average age of adult children caring for an aging parent is 46.4. Men who care for a spouse are an average of 62.5 years old. 66% of men work 40 hours a week. 62% of this group had to make special arrangements for work. 48% were tardy, left early, or took time off to handle caregiving duties. 15% had to take a leave of absence or work...

13 Jul

Posted at 15:06h in Blog

[vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column css=".vc_custom_1621365636104{padding-top: 10px !important;}"][vc_column_text] "At 80, one can take a long view and have a vivid, lived sense of history not possible at an earlier age. I can imagine, feel in my bones, what a century is like, which I could not do when I was 40 or 60." "I do not think of old age as an ever-grimmer time that one must somehow endure and make the best of, but as a time of leisure and freedom, freed from the factitious urgencies of earlier days, free to explore whatever I wish, and to bind the thoughts and feelings of a lifetime together." Dr. Oliver Sachs There will be a shift in the global aging population from 7% today to 20% in the next few decades. This growth will be one of the most significant social, economic, and political transformations of our time. It will force changes in systems, have an impact on families, and will require new solutions. Though older adults are a reigning economic segment, the attitudes and stereotypes about aging persist, and market innovation to meet their needs is lagging. Collaboration among policymakers, civil society, academia, and the private sector is crucial to creating holistic solutions that promote older adults' safety, autonomy, well-being, and dignity. Many societies have outdated beliefs about aging. For example, older adults are often described as frail, as "challenges" to be addressed, and they are discriminated against, particularly in the workplace, where their experience and knowledge should count. While we celebrate the birth and growth of children and their early adulthood, we fail to respect those with wisdom and important stories to pass down to younger generations. Marketing companies tend to focus on millennials and Gen Z, but the baby boomers are largely forgotten as one of the most significant economic segments. In the early days of the Covid-19 pandemic, one of the most pressing concerns was best communicating information to those at greatest risk — particularly the elderly. Unfortunately, many attempts were riddled with stereotyped depictions of frail, lonely, and incompetent older people. In doing so, messages from advertisers, public health officials, and policymakers may have failed to resonate with large swaths of their targeted audience. Yet, given a rapidly aging population, effective messaging to older people holds national importance for public health and the marketing of goods and services. Getting old isn't nearly as bad as people think it will be. Nor is it quite as good. On aspects of everyday life ranging from mental acuity to physical dexterity to sexual activity to financial security, a new Pew Research Center Social & Demographic Trends survey on aging among a nationally representative sample of 2,969 adults finds a sizable gap between the expectations that young and middle-aged adults have about old age and the actual experiences reported by older Americans themselves. These disparities come into sharpest focus when survey respondents are asked about a series of negative benchmarks often associated with aging, such as illness, memory loss, an inability to drive, an end to sexual activity, a...

09 Jun

Posted at 13:42h in Blog

[vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column css=".vc_custom_1621365636104{padding-top: 10px !important;}"][vc_column_text]Bob Dylan turned 80 years old two weeks ago, on May 24, 2021. For those of us who experienced him as a rebel of the 1960s, it's difficult to imagine him as an octogenarian. And yet, he's still here: seemingly as indefatigable as ever in his desire to write songs and take his music on the road. I loved Bob Dylan before I even knew his name. In the summer of 1963, the year I turned 14, I discovered the music of Peter, Paul, and Mary. The artist couple who taught arts and crafts at the summer camp I attended played the famous folk trio's first three albums continually in their studio. I was entranced the moment I heard them. It was the first music in my life I felt passionate about, and it had an enormous impact on my musical tastes going forward. Bruce Springsteen was in the car with his mother when he first heard "Like a Rolling Stone." He said it was as if "somebody kicked open the door to your mind." For me, it was more like someone had ripped open a window into my emotions. In the wake of my parents' separation, I felt confused, uncertain, scared, sad, and lonely. But there was something about how Dylan sang out the line "How does it feel?" that electrified me. It felt as though he'd tracked me down in my bedroom and challenged me to stop being so numb — to think about what I was feeling. Dylan is quoted as saying, "OK, a lot of people say there is no happiness in this life, and certainly there's no permanent happiness. But self-sufficiency creates happiness. Just because you're satisfied one moment — saying yes, it's a good meal, makes me happy — well, that's not going to necessarily be true the next hour. Life has its ups and downs, and time has to be your partner, you know? Really, time is your soul mate. I'm not exactly sure what happiness even means, to tell you the truth. I don't know if I personally could define it." Dylan isn't obsessed with aging: he has aged well, and his work in these latter years has reflected someone who doesn't have to struggle to come to terms with old age, but rather someone still filled with vibrancy, trying to make the most of whatever days remain. He's comfortable in his aged skin; in fact, he looks more comfortable than he ever has before, the master of his domain. "To live outside the law, you must be honest." True to his word, that's what Bob Dylan is, honest. The man doesn't shy away from his age. When you listen to Dylan's recent compositions, you hear the silvery voice of an 80-year-old man and all that he has experienced in those years. I met Bob Dylan in February 1971 at a synagogue in Far Rockaway, NY. The occasion was a Sheva Brachot Meal. The seven blessings (Sheva Brachot...

18 May

Posted at 19:20h in Blog

[vc_row css_animation="" row_type="row" use_row_as_full_screen_section="no" type="full_width" angled_section="no" text_align="left" background_image_as_pattern="without_pattern"][vc_column css=".vc_custom_1621365636104{padding-top: 10px !important;}"][vc_column_text]Loneliness is the uncomfortable feeling of social isolation that arises when an individual perceives that the quality or quantity of their social relationships is less than the quality or quantity of social relationships they desire. Loneliness can have a detrimental impact not only on wellbeing and health, but also on productivity and functioning in daily life. Loneliness is different from social isolation, which is an objective measure of the number of friends, family, or other social connections an individual has and the frequency of those connections. Loneliness is subjective and depends on how the individual feels about their situation. Social isolation and loneliness are public health issues that affect more than one-third of adults, with seniors most at risk for depression, substance abuse, and suicide triggered by feelings of isolation. Health risks associated with loneliness and social isolation are comparable to the dangers of smoking and obesity, increasing mortality risk by up to 30%. Given the links between loneliness and health status, there is a need for increased awareness among both the public and healthcare providers that loneliness is a condition that, like chronic pain, can afflict almost anyone. Loneliness is a significant predictor of poor health. In a 2010 AARP Research survey of adults age 45 and older, among respondents who rated their health as “excellent,” only 25% were likely to be lonely, compared to 55% for those who rated their health as “poor.” Loneliness is a common source of distress, suffering, and impaired quality of life for adults older than 60, and is a predictor of functional decline and death, according to a 2012 study. Some 19% of older adults report feeling lonely fairly frequently, according to a study on social connectedness based on data from the National Social Life Health and Aging Project. Relative to others, lonely adults tend to have lower incomes; are less likely to be married; live alone; and have poorer self-rated health, more physical limitations in carrying out daily activities, and fewer friends. They also socialize, volunteer, and participate in organized groups less frequently. According to an AARP initiative, causes of social isolation include poor physical and mental health, poorly designed communities, and major life events such as loss of friends or a partner. Risk factors include lack of transportation, mobility impairment, untreated hearing loss, and limited opportunity to engage with others. Health outcomes in older adults may be improved by promoting social engagement and helping seniors maintain interpersonal relationships, according to a 2012 study. Many older adults suffer from frequent feelings of loneliness, but others are relatively unscathed by loneliness, according to a 2017 study. Factors that combat loneliness are a support network of friends and family and improving physical problems that limit independence and the ability to get out and about. Current research suggests that immigrant, and lesbian, gay, bisexual populations experience loneliness more often than other groups. Latino immigrants, for example, “have fewer social ties and lower levels of social integration than US-born Latinos.” First-generation immigrants experience stressors that can...

09 Mar

Posted at 10:36h in Blog

COVID-19 infections continue to rise in the United States. Over three million people have come down with the virus, and nearly 140,000 people have died. Data shows that the racial and ethnic health disparities that persist in the nation's health care system are making the pandemic especially lethal for communities of color. Furthermore, while the majority of these deaths have taken place within hospitals across the country, the second-most-common setting in nursing homes and long-term care facilities—indicating not only the disproportionate impact of COVID-19 among the aging population but also the difficulty these facilities are having as they struggle to control the spread of COVID-19 among residents and staff. But few studies have focused on the intersection of these two populations, says AARP's Elaine Ryan, vice president of state advocacy and strategy integration. "The study is critically important," she explains, "because it is the first type of data and insights that show how vulnerable these minority populations in the facilities are." "The findings are devastating," Ryan adds. "They show that there's structural racism and inequality in long-term care, and immediate, and we must act immediately to get these residents more help and support." A new study suggests that U.S. nursing homes with a high proportion of black residents appear to deliver poorer care and perform worse financially than homes with no or few minority patients. In long-term care facilities without black and Hispanic residents, revenues and profit margins are higher, and health care outcomes seem to be better, according to the study of more than 11,000 U.S. nursing homes. The two-tiered system is partly due to the fact that black residents rely on Medicaid -- government-funded coverage for the poor -- for long-term care more than others do, and reimbursement rates under Medicaid are lower than private payor self-pay rates, the researchers noted. But money doesn't tell the whole story. "It isn't only the financial performance [of nursing homes] that affects performance," said Latarsha Chisholm, assistant professor at the University of Central Florida and lead author of the study published recently in Health Services Research. "There has to be something else affecting quality," Chisholm said. "I want to understand what management practices promote improved care in nursing homes with high proportions of minorities that don't have disparities in care," she added. For the study, the researchers reviewed the quality and financial data from 2014 to 2019 for about 11,500 freestanding Medicare- and Medicaid-certified nursing homes. Government facilities were excluded. Data were pulled from Medicare cost reports, so facilities without any Medicare beds were excluded. Financial data included operating profit margins, net income, revenue, and operating costs adjusted for the number of patients per day. Quality data included the ratio of nursing staff to patients, success in preventing pressure ulcers, help with walking and getting out of bed, prevention of urinary tract infections, and the incidence of medication errors, citations by governmental agencies, and related factors. The study found that nursing homes with a high proportion of black residents had lower costs and lower revenues, and tighter operating margins. Pressure ulcer prevention...