Black and Hispanic residents in U.S. nursing homes are significantly less likely to have access to Alzheimer’s disease special care units (ASCUs), according to a new study published in JAMA Network Open. These specialized units, which improve outcomes for people with dementia, are available in only 13.6% of nursing homes nationwide.
The study analyzed data from over 13,000 facilities and found that nursing homes with higher percentages of Black residents were up to 45% less likely to offer ASCUs. Facilities with more Hispanic residents also showed reduced access, though disparities were less responsive to policy changes.
Researchers found that Medicaid reimbursement rates play a critical role. In states where Medicaid payments covered a greater share of care costs, racial disparities in ASCU availability narrowed—and in some cases, disappeared. In states with the most constrained Medicaid funding, nursing homes with high proportions of Black residents were 68% less likely to have ASCUs. That gap shrank to 45% in moderately funded states and was statistically insignificant in states with the most generous Medicaid payments.
“Racial disparities in specialized dementia care may be mitigated and even eliminated by more generous Medicaid payments,” the authors concluded. However, disparities for Hispanic residents persisted regardless of funding levels, highlighting the need for more accurate data collection and targeted policy solutions.
See: “Medicaid Payments and Racial and Ethnic Disparities in Alzheimer Disease Special Care Units” (August 4, 2025)
