DAVID GREENE, HOST:
So there is one thing that distinguishes the nursing homes in New York that have reported the highest number of patient deaths from COVID-19. An NPR analysis shows it is not the quality of the nursing home; it is the percentage of people of color who live there. NPR investigative correspondent Joseph Shapiro has more.
JOSEPH SHAPIRO, BYLINE: Nursing homes are on the front lines of this pandemic. Residents make up almost 1 out of 5 deaths nationwide from COVID-19. They're often frail; they have underlying health problems. Nurse aides who work for low wages do the hands-on care - get people out of bed, bathe them, take them to the toilet. They and other staffers were some of the last to get personal protective equipment - those masks and gloves. That made it easier for the virus to spread.
DORA HUGHES: For all of our pandemic response, much of the attention has very appropriately focused on hospitals.
SHAPIRO: Dr. Dora Hughes is a professor of public health at George Washington University.
HUGHES: But I think, from what we've seen with the nursing home, it's a fairly stark reminder that we need to really expand our thinking in terms of essential workers. In a nursing home, the direct care staff should have been a greater priority.
SHAPIRO: Some 20 states are documenting COVID-19 deaths at nursing homes - if the facilities report them. NPR took the list from New York, the state with the most deaths by far. New York named 73 nursing homes where six or more residents have died. In one facility, 55 people died.
We used the federal government's system for rating nursing homes. It gives them a star rating from 1 to 5. And we found those nursing homes that recorded deaths actually had better quality scores than other nursing homes in New York state.
I expected we were going to find these were the nursing homes with the lowest quality ratings.
HUO JINGNAN, BYLINE: Yeah, that's what I thought as well.
SHAPIRO: That's my colleague Huo Jingnan. She ran the numbers. We looked at staffing levels. They were about the same for nursing homes that reported deaths and those not on the list. Their reliance on Medicaid patients, who bring lower reimbursements, was about the same, too. The nursing homes with outbreaks were often larger facilities. Half were in New York City.
There was one thing that really stood out in NPR's analysis - race and ethnicity. Those nursing homes where residents died were far more likely to be disproportionately made up of people of color - black, Latinx. Last year, NPR collected a huge data set on nursing homes, including numbers that allow us to look at the racial demographics of every nursing home in the United States. Our finding of that racial imbalance is not unique to nursing homes. We know that across the country, black people and Hispanic, too, are dying at disproportionate rates from COVID-19.
CLYDE YANCY: It is not surprising that this is exaggerated.
SHAPIRO: Dr. Clyde Yancy is the chief of cardiology at Northwestern University School of Medicine. He wrote in The Journal of the American Medical Association about the long history of racial disparities in health care and how it plays out now in this pandemic.
YANCY: Someone living in a nursing home who has suffered more extensive complications from a disease process because of already embedded health disparities, one can only imagine what happens when that individual now is facing coronavirus infection, potential COVID-19 complications.
SHAPIRO: Years of poverty and inequality led to less access to health care, to hard lives and jobs, to a greater likelihood of developing diabetes, asthma and other conditions that now put people in those nursing homes at greater risk. The NPR data adds one more piece of evidence to that lesson from this pandemic - that people of color are dying at much higher rates. And in our analysis, that's the bottom line in nursing homes, as well.
Joseph Shapiro, NPR News.
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