Saint Louis University Journal of Health Law & Policy
Document Type
Article
Abstract
This Essay explores several dimensions of how segregation, separation, and shielding from view permit and contribute to the ethically problematic state of nursing home care in the United States. A quarter of a century ago, the Supreme Court recognized in the Olmstead decision that institutional care can function to segregate disabled people (whether young or old) from the richness of community life. Research over the past few decades confirms that racial segregation exists within the nursing home industry, and during the COVID-19 pandemic, the correlations between nursing homes’ racial makeup and their level of COVID fatalities were shocking. On another level, separating nursing home residents and those charged with caring for them from the community view increases opportunities for undetected neglect or abuse of residents. At the same time, that separation permits those living in the community to easily avert our attention from those harms. Concerns about abuse and neglect become more pointed when pressures from investors threaten to overwhelm a commitment to maximizing resident welfare, a phenomenon highlighted by researchers studying private equity ownership of nursing homes. Here, the hidden and opaque nature of ownership structures hinders attempts to regulate to improve the safety and quality of care. All these dimensions of segregation, separation, and shielding from view are particularly troubling considering the government’s dominant role in paying for nursing home care in the United States.
Recommended Citation
Mary Crossley,
The Layered Harms of Nursing Home Segregation,
18
St. Louis U. J. Health L. & Pol'y
(2025).
Available at:
https://scholarship.law.slu.edu/jhlp/vol18/iss2/8