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Striving for Equal Access and Quality, but Settling for the Status Quo: Is Title VI more Illusory than Real?

2005; RELX Group (Netherlands); Linguagem: Inglês

1556-5068

Ruqaiijah Yearby,

Healthcare innovation and challenges

Kelley Mitchell, a 75-year-old woman, lives alone in Lincoln Park, an affluent neighborhood in a major city in the Midwest. One day while rushing to the telephone, she slips and falls down the stairs and is immediately raced to the hospital in her neighborhood. Diagnosed with a hip fracture, she recuperates in the hospital for several weeks. Her condition improves, but she cannot take care of herself, so the hospital discharge staff plans to transfer her to a nursing home on November 4, 2005. On the same day that Kelley is rushed to the hospital, her friend Blanche Manning, a 75-year-old woman living alone, trips and fractures her hip. Blanche also resides in Lincoln Park and is immediately raced to the same hospital as Kelley. Blanche is diagnosed with a hip fracture and recuperates from the surgery for several weeks. Unable to care for herself, Blanche is told by the hospital discharge staff that she will be transferred to a nursing home on November 4, 2005. Seeking to transfer Kelley, the hospital discharge staff contacts the sole nursing home in Lincoln Park, giving Kelly's information and requesting a transfer. The request is rejected because all their Medicaid certified beds are filled. Half an hour later, the same staff contacts the same nursing home on behalf of Blanche, giving her information and requesting a transfer. The nursing home is still out of Medicaid certified beds; however, it accepts Blanche and certifies an additional bed as Medicaid. Blanche is immediately transferred to this high-quality nursing home, while Kelly is transferred to a poor quality nursing home located in an unsafe neighborhood fifty miles from her home. Blanche's nursing home is like a resort, while Kelly's nursing home is atrocious. For example, the nursing staff does not rotate Kelley or provide her with a water mattress. As a result, Kelley develops several painful bedsores, while Blanche is rotated often and her condition is quickly improving. Last week both nursing homes were surveyed for compliance with the Medicaid quality of care regulations. Blanche's nursing home did not have any violations, whereas Kelley's nursing home had several violations including its failure to prevent bedsores and offer adequate pain management. Even though their payment status, physical condition, neighborhood of residency, and educational level are the same, Kelley and Blanche are placed in significantly different nursing homes. The only difference is their race. Blanche is White and Kelley is African-American. Two decade's of empirical data show that the story of these two friends, Blanche and Kelley, is a common occurrence. Many legal and medical experts, such as Professors Sidney Watson and David Barton Smith, assert that the most likely explanation for Kelley's lack of equal access to quality nursing home care is racial discrimination. But how can this be the case forty-one years after the passage of Title VI, which prohibits racial discrimination by health facilities that receive federal funding? Thus, one must ask whether the protections offered by Title VI are more illusory than real in the health care industry.