The faces of elderly Americans in recent decades have not been reflected by those seen in skilled nursing facilities (SNFs).

Among SNF residents aged 65 and over in 2012, 86 percent were white, 8.8 percent were black, 7.3 percent were Hispanic, and 3.8 percent were Asian, according to U.S. Census Bureau data. Nursing care centers had been primarily populated by white residents for the past two decades. Compared with whites, ethnic residents are typically cared for in SNFs with limited clinical and financial resources, low nursing staff, and high deficiency citation numbers.

Yet the tide may be turning. A recent Health Affairs article indicates that from 2006 to 2011, citations and disparities across facilities with four different concentrations of ethnic minority residents have decreased. The reason? Increased Medicaid payments tied to quality improvement measures.

“Improved payments will help all nursing homes, in particular nursing homes used by racial and ethnic minority residents because minorities are predominately Medicaid residents,” says lead author Yue Li, associate professor in the Department of Public Health Sciences at the University of Rochester Medical Center in New York.

Culture partially explains the disparity seen in SNFs. Hispanics view SNFs as a last resort, says Li, who adds that Hispanics and Asians have more familial support—adult children typically house and/or look after their elderly parents. Additionally, ethnic minorities tend to avoid institutional care, says Li.

Yet a rise has been seen in SNF admissions for Hispanics, Asians, and blacks and a drop in whites. For one, all ethnic groups have a longer life expectancy due to improved health care. Also, the SNFs have become big business, compared with 20 to 30 years ago—more SNF beds are now available in the community. Lastly, a concurrent rise in assisted living may attract higher socioeconomic elders, in particular, white elders.

During the five-year observation period in Li’s study, the average number of health care-related and immediate-jeopardy deficiencies essentially decreased for SNFs in all groups of ethnic minority concentrations. Life safety deficiencies actually increased a bit over time.

When Li’s team examined Medicaid payment policies over this time period, they found that the increased payments improved both overall SNF quality and disparities. In their paper, they caution that “these efforts may not lead to equally improved care for all subgroups of residents or in all nursing facilities… To our knowledge, national initiatives targeting racial/ethnic or site-of-care disparities in nursing homes do not exist.”