The history of nursing home bed supply in Chicago: The effect of federal policy and urban settlement on utilization

In the past decade, national nursing home utilization rates for African Americans have risen above those of White elders suggesting improved access to care. This study examines the effect of Medicaid upon the supply of long-term care facilities in Chicago communities by tracing the construction and placement of homes at three points in the development of federal long-term care policy compared to the settlement and segregation of the city's neighborhoods by ethnoracial groups. Spatial analysis of nursing home distribution shows why facilities built after 1965 are more likely to serve African Americans. The policy implications of changing long-term care utilization patterns are discussed.