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The higher adjusted hospitalization rates in FP versus NP facilities is consistent with previous research from U.S. authors. However, the superior performance by the NP sector is driven by NP-owned facilities connected to a hospital or health authority, or that had more than one site of operation.

ResearchRecherche N nursing homes provide long-term housing, support and direct care to members of the community who are unable to function independently because of medical, physical and cognitive disabilities. Although only a small proportion of older Canadians reside in nursing homes (18% of those ≥ 80 years), the majority (81%) of long-term care residents are frail elderly people over the age of 65.1 Government-funded long-term care in Canada has been provided for many years by a mix of not-for-profit (nonproprietary) and for-profit (proprietary) facilities. The ratio of this mix varies greatly by province. For example, in Ontario 52% of publicly funded nursing homes are for-profit, as compared with 15% in Manitoba. 2Previous studies from the United States have shown that having more direct-care personnel is associated with better care in nursing homes.3-7 Specifically, higher numbers of registered-nurse hours per resident-day have been associated with fewer violations of care standards 4 and improved functional ability of residents.7 Schnelle and colleagues examined 21 nursing homes in California and found that the homes with the highest number of nurse aides performed significantly better in 13 of 16 quality-of-care measures than the homes with fewer nurse aides. 6 Although there has been little research on staffing levels and nursing home care in other countries, health policy-makers in the United Kingdom 8 and Australia 9 have begun to call for greater accountability for public resources spent in this area.The American literature has also shown that, compared with for-profit nursing homes, not-for-profit facilities have higher direct-care staffing levels 4 and lower staff turnover rates.10,11 However, the majority of nursing home care in the United States is delivered by the for-profit sector, whereas in Canada the not-for-profit sector constitutes the majority. This may result in a difference in the informal benchmarks for staffing levels between the 2 countries. There also may be a wider variation in wages and working conditions among nursing homes in the United States, which potentially confounds the comparison between for-profit and not-for-profit facilities.We compared staffing levels of nursing and support staff in publicly funded long-term care facilities by ownership type (not-for-profit v. for-profit) in British Columbia at a time when the majority of publicly funded not-for-profit and for-profit facilities employed a unionized labour force with standardized wages and benefits set by a master collective agreement.In British Columbia, approximately 70% of publicly funded nursing homes are nonproprietary (not-for-profit) Currently there is a lot of debate about the advantages and disadvantages of for-profit health care delivery. We examined staffing ratios for direct-care and support staff in publicly funded not-for-profit and for-profit nursing homes in British Columbia. Methods: We obtained staffing data for 167 long-term care facilities and linked these to the type of facility and ownership of t...

This article uses the concept of continuity of care to examine the implications of health-system restructuring for workers and staff in the BC home support system. Home support primarily serves frail seniors living in poverty and has the potential to provide assistance with tasks like bathing, dressing, and toileting, as well as offer social support and relational care to isolated clients. Through presentation of qualitative data from focus groups and interviews with home support workers and clients in the Greater Vancouver area, we demonstrate how the casualization and intensification of work in a context of increasing client acuity levels has diminished both continuity and quality of care. This article discusses how restructuring in the home support sector in BC has reduced the overall number of persons under care in the system, disrupted continuity of care, and compromised quality.

P ublic funds can be used to pay for health care services that are delivered either by for-profit or not-for profit agencies. A systematic review of patient outcomes in US hospitals by ownership status showed that not-for-profit hospitals tended to produce better results.1 Although there are no Canadian acute care hospitals in the for-profit sector, the issue of interest here is whether the same trend in outcomes applies to for-profit and not-for-profit ownership of long-term care facilities.About 60% and 30% of all publicly funded long-term care beds in Ontario and British Columbia, respectively, are in forprofit institutions.2,3 The co-existence of for-profit and notfor-profit providers in the same province creates a "natural laboratory" for examining their differences. This is particularly true because the funding paid by the province to these facilities is tied to resident care requirements and thus the same amount is paid per standardized patient whether he or she is in a for-profit or a not-for-profit facility. Despite this, there has been relatively little Canadian research that examines the experiences of residents in these 2 types of facilities. Although there is an abundance of evidence from the United States demonstrating superior performance of the not-forprofit sector in measures of quality of care, there are claims that these findings have limited generalizability in Canada because of differences in the 2 countries' health care systems. However, a few Canadian studies are now starting to provide a portrait of what public investment "buys" in for-profit and not-for-profit facilities. How is the money spent?Long-term care facilities, like hospitals, are labour-intensive; therefore, staffing costs account for a significant portion of total expenditures. Unlike many parts of the United States, Canada has no legislated minimal requirements for staffing in longterm care facilities. Instead, institutions either face requirements for minimum spending in different categories as dictated by "funding envelopes" (as in Ontario), or are free to choose how to apportion their funding (as in British Columbia).There is now increasing evidence that the for-profit and not-for-profit sectors in Canada make different spending decisions. In an Ontario study, government-operated facilities were found to provide more hours of direct patient care per resident than for-profit facilities, although the public-sector facilities also care for residents with greater health needs.2 In British Columbia, not-for-profit facilities were also found to provide more hours of direct patient care per resident than for-profit facilities, with the same funding level from government; this difference remained after adjustment for the size and level of care of the facilities.3 Adjustment for the mix of patients cared for by the 2 types of facilities is important. For example, most extended-care beds, reserved for the care of the frailest elderly patients, are in not-for-profit facilities.What are the outcomes of care?Do differences in staffing...