For-profit nursing homes more likely than non-profits to be cited for poor quality

By Maureen McInaney

For-profit nursing homes are much more likely than their non-profit
counterparts to be cited for deficient quality, according to a UCSF/Harvard
study. Quality was particularly poor at facilities owned by nursing home
chains, according to Charlene Harrington, RN, PhD, professor of social and
behavioral sciences in the UCSF School of Nursing and lead author of a study
published in the September issue of American Journal of Public Health.

The researchers analyzed data from 1998 government inspections of 13, 693
nursing homes that receive Medicare or Medicaid payments - virtually every
nursing home in the United States. Inspectors cited for-profit facilities for
deficient care 46.5% more frequently than non-profits (and 43% more frequently
than public nursing homes). For-profit homes had significantly higher rates of
severe problems - situations in which patients were actually harmed by poor
quality, according to Harrington.

Almost two-thirds of all United States nursing homes are for-profit, she
explained. “Periodic public scandals have raised concerns that for-profit
facilities may be skimping on care in order to make a profit. This study is
evidence that for-profit facilities do, in fact, deliver worse quality care.
Nursing home advocates, discharge planners and the public need to be aware of
the lower quality in investor-owned facilities and take this into account when
selecting a nursing home,” she said.

The researchers noted that for-profit nursing have fewer staff members to care
for patients. Registered nurse or licensed practical nurse staffing per patient
at for-profit facilities was 31.7 % lower than at non-profits. Nurse aide
staffing per patient at for-profit facilities was 11.9 % lower than at

“When for-profit chains understaff their facilities and underpay their workers,
the chain makes money but quality suffers,” said Steffie Woolhandler, MD, MPH,
associate professor of medicine at Harvard Medical School and a co-author of
the study. “For the 1.6 million Americans who reside in nursing homes, the
quality of care largely determines quality of life. Nursing homes care for many
people too frail, sick and powerless to choose or even protest their care. It
is unwise to entrust such vulnerable patients to profit-seeking firms.”
“Our decade-old experiment with market medicine is a failure,” added co-author
David Himmelstein, MD, associate professor of medicine at Harvard Medical
School, who serves as national spokesperson for Physicians for a National
Health Program. “It’s time to implement national health insurance, including
coverage for high quality long term care.”

Of 13, 693 nursing homes, 9,009 (65.8%) were investor-owned, 3,789 (27.7%) were
nonprofit, and 895 (6.5%) were public. Deficiency rates were examined in three
areas: 1) quality of care, which included physician, nursing, dietary,
rehabilitative, dental pharmacy and infection control services; 2) quality of
life, which included concerns with patient dignity and choice, patient rights,
the physical environment, and the provision of social services and activities;
3) other, which included administrative procedures, record keeping and
personnel policies.

Additional authors of the study include Joseph Mullan, PhD, UCSF assistant
professor of social and behavioral sciences in the UCSF School of Nursing; and
Helen Carrillo, MS, statistician in the UCSF department of social and
behavioral sciences.

The study was funded by the Agency for Healthcare Research and Quality (AHRQ).
Agency research provides evidence-based information to improve the quality of
health care services and to help people make more informed decisions. AHRQ was
formerly known as the Agency for Health Care Policy and Research. Funding was
also provided by the Open Society Institute of the Soros Foundation.