The Striking Racial Divide in How COVID-19 Has Hit Nursing Homes

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The coronavirus pandemic has devastated the nation’s nursing homes, sickening staff members, ravaging residents and contributing to at least 20 percent of the nation’s Covid-19 death toll. The impact has been felt in cities and suburbs, in large facilities and small, in poorly rated homes and in those with stellar marks.

But Covid-19 has been particularly virulent toward African-Americans and Latinos: Nursing homes where those groups make up a significant portion of the residents — no matter their location, no matter their size, no matter their government rating — have been twice as likely to get hit by the coronavirus as those where the population is overwhelmingly white.

More than 60 percent of nursing homes where at least a quarter of the residents are black or Latino have reported at least one coronavirus case, a New York Times analysis shows. That is double the rate of homes where black and Latino people make up less than 5 percent of the population. And in nursing homes, a single case often leads to a handful of cases, and then a full-fledged outbreak.

The nation’s nursing homes, like many of its schools, churches and neighborhoods, are largely segregated. And those that serve predominantly black and Latino residents tend to receive fewer stars on government ratings. Those facilities also tend to house more residents and to be located in urban areas, which are risk factors in the pandemic.

Yet the disparities in outbreaks among homes with more Latino and black residents have also unfolded in confusing ways that experts say are difficult to explain.

The race and ethnicity of the people living in a nursing home was a predictor of whether it was hit with Covid-19. But the Times analysis found that the federal government’s five-star rating system, often used to judge the quality of a nursing home, was not a predictor. Even predominantly black and Latino nursing homes with high ratings were more likely to be affected by the coronavirus than were predominantly white nursing homes with low ratings, the data showed.

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But the Times analysis found that a racial disparity remained even after accounting for a variety of factors, including the size of a nursing home, the infection rate in the surrounding county, the population density of the neighborhood and how many residents had Medicaid or Medicare.

Large homes with few black and Latino residents were less likely to have outbreaks than large ones with more black and Latino residents. A home in an urban area was less likely to get hit by the virus if it had a small black and Latino population.

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About 1.3 million people live in the nation’s nursing homes, according to federal data. About 80 percent of those residents are identified as white by nursing home administrators.

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