Abstract
Long-term services and supports for older persons in the United States are provided
in a complex, racially segregated system, with striking racial disparities in access,
process, and outcomes of care for residents, which have been magnified during the
Coronavirus Disease 2019 pandemic. These disparities are in large measure the result
of longstanding patterns of structural, interpersonal, and cultural racism in US society,
which in aggregate represent an underpinning of systemic racism that permeates the
long-term care system's organization, administration, regulations, and human services.
Mechanisms underlying the role of systemic racism in producing the observed disparities
are numerous. Long-term care is fundamentally tied to geography, thereby reflecting
disparities associated with residential segregation. Additional foundational drivers
include a fragmented payment system that advantages persons with financial resources,
and reimbursement policies that systematically undervalue long-term care workers.
Eliminating disparities in health outcomes in these settings will therefore require
a comprehensive approach to eliminating the role of systemic racism in promoting racial
disparities.
Keywords
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Article info
Publication history
Published online: March 25, 2021
Footnotes
The authors declare no conflicts of interest.
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© 2021 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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