Living and Working in Economically Deprived Neighborhoods: LTC Facility Location Impacts Staffing

Several years ago, the Robert Wood Johnson Foundation (RWJF) developed an interactive web tool that calculated life expectancy based upon the zip code where an individual was raised.  The notion that the area in which we lived dictates our life expectancy is troubling but relevant to our understanding of both health care access and the opportunities for individuals to attain licensure as health care providers.

The RWJF calculation is based on social determinants of health, which show that economically deprived neighborhoods generally have underfunded and/or underperforming schools. The poorer quality of those schools limit opportunities for students to attend college. Without a college degree, individuals may be precluded from obtaining employment that provides a health care benefit. Therefore, the issues associated with growing up in an economically deprived neighborhood can reverberate throughout an individual’s lifespan and adversely affect their ability to access quality health care through employer health benefits.

Jason R. Falvey, DPT, PhD, and his colleagues at the University of Maryland have taken research into the impact of neighborhood deprivation a step further. They examined the correlation between staffing patterns and the location of long-term care facilities. Not surprisingly, they concluded that significant disparities in staffing were found between facilities located in economically deprived neighborhoods as compared to those located in areas with greater economic security. These disparities included not only 30% fewer registered nurses and 5% fewer certified nursing assistants, but also 38% fewer physical and occupational therapists.

There is a connection between the economics of a neighborhood and the likelihood of having poor health outcomes which, in turn, increases the risk of institutionalization. In facilities located in under-resourced communities, it is more likely that staffing may be negatively affected. We need to draw our attention to the impact of economics on the health of our fellow citizens as well as staffing at facilities which care for medically complex individuals.