S Fashaw, L Chisholm, V Mor, K Thomas, A Liu, and D Gammonley
Abstract
Previous research suggests Black residents are more likely to be physically restrained or chemically restrained compared to White nursing home (NH) residents. The purpose of this study is to examine how NH characteristics, specifically the racial composition of residents and the proportion of Medicaid residents, are associated with the use of physical and chemical restraints across a 15-year period. This study used national data from the LTCFocUS.org. The sample consisted of 12,964 US NHs between 2000 and 2015. The final models consisted of panel data two-way fixed effects models, consisting of year and facility fixed effects. There were 21,837 high physical restraint facility years (>14.64%) and 83,931 high chemical restraint facility years (>26.15%). NHs having higher proportions of Black residents were not more likely to have higher physical restraint use (β=-0.00016; p=0.308) but were significantly less likely to have high chemical restraint use (β=-0.0015; p<.0001). NHs with higher proportions of Hispanic residents also were less likely to have high rates of physical restraint use (β=--0.004; p<.0001). Medicaid-reliant NHs were associated with a higher probability of high chemical restraint use (β=0.0007; p<.0001). Findings from this study indicates a NH’s reliance on Medicaid contributes to high chemical restraint use but that the racial/ethnic composition of the facility may not be an important factor. Nevertheless, the relationship with race warrants further examination, as results may be due to location, the presence of a cultural protective factor (e.g. ethnic enclaves), or actual process and/or practice differences. Future research should consider using resident-level data.