A first-of-its-kind study finds that the nation’s largest for-profit nursing home chains deliver significantly lower quality of care than non-profit and government-owned nursing homes due primarily to reduced staffing.
The analysis by the University of California San Francisco comes as no surprise to culture change advocates and organizations working to improve the quality of care in nursing homes. The study documents the nation’s 10-largest for-profit nursing home chains’ strategies to cut costs by reducing staffing, which resulted in “significantly lower quality of care.”
“The top 10 chains have a strategy of keeping labor costs low to increase profits,” report author Charlene Harrington, professor emeritus of sociology and nursing at the UCSF School of Nursing, said in a written statement. “They are not making quality a priority.”
The report compared staffing levels and facility deficiencies between non-profit and government-operated nursing homes with the nation’s 10 largest for-profit chains, which operate about 2,000 nursing homes in the U.S. and control approximately 13 percent of the country’s nursing home beds.
The 10 largest for-profit chains in 2008 were HCR Manor Care, Golden Living, Life Care Centers of America, Kindred Healthcare, Genesis HealthCare Corporation, Sun Health Care Group, Inc., SavaSeniorCare LLC, Extendicare Health Services, Inc., National Health Care Corporation, and Skilled HealthCare, LLC.
From 2003 to 2008, the for-profit chains had fewer nurse “staffing hours” than non-profit and government nursing homes. The for-profits had the sickest residents, but their total nursing hours were 30 percent lower than non-profit and government nursing homes. Moreover, the researchers found the top chains were well below the national average for total nurse staffing and below the minimum nurse staffing recommended by experts.
The 10 largest for-profit chains were cited for 36 percent more deficiencies and 41 percent more serious deficiencies than the best facilities. Deficiencies include failure to prevent pressure sores, resident weight loss, falls, infections, resident mistreatment, poor sanitary conditions, and other problems that could seriously harm residents.
According to the researchers, nursing home chains have undergone a considerable expansion in recent decades. A number of chains were publicly-traded companies until the early 2000s, when five of the country’s largest chains went bankrupt.
More recently, some of the largest publicly held chains (including four of the nation’s top 10) were purchased by private equity investment firms, which invest funds received from investors. The study found that the four largest for-profit nursing home chances purchased by private equity companies had more deficiencies after being acquired. The study is the first to make the connection between worse care following acquisition by private equity companies.
The article is published online in advance of print publication in Health Services Research http://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2011.01311.x/full