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August 31, 2001

For-Profit Nursing Homes More Likely Than Non-Profits to be Cited for Poor Quality

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 non-profits.

"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.


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