Differences in Timely Goals of Care Discussions in Nursing Homes Among Black Residents.

Background: In the United States, disparities persist in end-of-life care outcomes between Black and White nursing home (NH) residents, particularly concerning infection-related management. Timely goals of care (TGOC) discussions are crucial for improving end-of-life outcomes but exhibit racial variations within NHs that are not well understood.

Objectives: Examine the association between the proportion of Black residents within NHs and TGOC discussion related to infection management.

Design: A national analysis of palliative care survey data from NHs with the Minimum Dataset 3.0 and administrative data.

Setting/subjects: 892 NHs representing a weighted sample of 14,981 facilities.

Measurments: TGOC discussions related to infection management were quantified using an index score from the palliative care survey (range: 0-18). Multivariable analyses assessed the association between the proportion of Black residents (≤2%, 2.1%-15%, >15%) and TGOC index scores.

Results: The majority of NHs were for-profit, chain-affiliated, urban facilities with fewer than 100 beds, serving both Medicare and Medicaid beneficiaries. In stratified analyses, NHs with 2.1%-15% (-0.97 score; 95%CI -1.86, -0.07; < .05) and 15% or more Black residents (-3.86 score; 95%CI -6.62, -1.10; < .01) showed lower TGOC index scores compared to NHs with 2% or fewer Black residents in the West. NHs with 2.1%-15% Black residents had 1.29 lower TGOC index scores compared to NHs with 2% or fewer Black residents (95%CI -2.51, -0.07; < .05) in the Northeast.

Conclusions: TGOC discussions in US NHs are influenced by the proportion of Black residents, highlighting the need for targeted interventions to address regional disparities and improve end-of-life care equity.