Long-Stay Nursing Home Residents With Dementia: Telemedicine Mental Health Use During the COVID-19 Pandemic

Objective: To examine racial and ethnic differences in telemedicine mental health (tele-MH) use among nursing home (NH) long-stay residents with Alzheimer's disease and related dementias (ADRD) during the pandemic.

Design: Observational study.

Setting and participants: The 2020-2021 Minimum Data Set 3.0, Medicare datasets, and Nursing Home Compare data were linked. A total of 259,467 NH long-stay residents with ADRD and 14,159 NHs were included.

Methods: The outcome variable was the percentage of NH ADRD long-stayers who used tele-MH in 2021. The main independent variables were NH racial and ethnic compositions (ie, percentages of Black and Hispanic residents) and individual race and ethnicity. We conducted a set of logistic regression models with NH random effect. We first included only individual characteristics and then added NH characteristics.

Results: Approximately 7% and 35% of the study cohort had tele-MH use and MH use in 2021, respectively. In our study cohort, 13.7% were Black, 6.6% were Hispanic, and 79.7% were White residents. The mean age was 83.4. After adjusting for NH characteristics, we found residents in NHs with a high proportion of Hispanic residents were more likely to use tele-MH both compared with those in NHs with a low proportion (odds ratio [OR], 1.867; 95% CI, 1.566-2.226), whereas residents in NHs with a high proportion of Black residents were less likely to use tele-MH both compared with those in NHs with a low proportion (OR, 0.843; 95% CI, 0.928-0.997).

Conclusions and implications: Telemedicine may offer an opportunity for NHs with a higher proportion of Hispanic residents to better address their needs for MH services. However, NHs with a higher proportion of Black residents may face challenges in telemedicine adoption. Future studies are needed to better understand factors that could impact tele-MH use in NHs and reasons that lead to racial and ethnic differences.