Do Nursing Home Chain Size and Proprietary Status Affect Experiences With Care?

Abstract

Background In 2012, over half of nursing homes were operated by corporate chains. Facilities owned by the largest for-profit chains were reported to have lower quality of care. However, it is unknown how nursing home chain ownerships are related with experiences of care. Objectives To study the relationship between nursing home chain characteristics (chain size and profit status) with patients' family member reported ratings on experiences with care. Data Sources and Study Design Maryland nursing home care experience reports, the Online Survey, Certification, And Reporting (OSCAR) files, and Area Resource Files are used. Our sample consists of all non-governmental nursing homes in Maryland from 2007 to 2010. Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food and meals; physical environment; and autonomy and personal rights. We identified chain characteristics from OSCAR, and estimated multivariate random effect linear models to test the effects of chain ownership on care experience ratings. Results Independent nonprofit nursing homes have the highest overall rating score of 8.9, followed by 8.6 for facilities in small nonprofit chains, and 8.5 for independent for-profit facilities. Facilities in small, medium and large for-profit chains have even lower overall ratings of 8.2, 7.9, and 8.0, respectively. We find similar patterns of differences in terms of recommendation rate, and important areas such as staff communication and quality of care. Conclusions Evidence suggests that Maryland nursing homes affiliated with large- and medium- for-profit chains had lower ratings of family reported experience with care.

Overall Quality Performance of Long-Term Care Homes in Ontario

“…In particular, it was established that not-for-profit and private homes perform similarly on quality. This is contrary to some review studies that have reported better results for not-forprofit versus for-profit (private) homes (Comondore et al 2009;Hillmer et al 2005;McGregor et al 2006;Tanuseputro et al 2015;You et al 2016). This discrepancy is likely because of the use of heterogeneous and non-standardized measures of quality in the literature -such as resident comfort, autonomy and security; home-like environment, privacy and dignity; hospitalization, mortality and infection prevalence; and staffing and pressure injuries -rather than the consistent set of nine performance measures (QIs) covered by the Qindex.…”

Performance and Penalties in Year 1 of the Skilled Nursing Facility Value‐Based Purchasing Program

“…For example, existing literature suggests that quality of care is lower and family experience is worse in nursing facilities that are for profit in nature or owned by corporate chains. [2][3][4][5] Another factor that may be associated with quality is size, with smaller facilities having higher quality than larger ones 6 ; literature also suggests that urban facilities have higher quality than rural ones. 7,8 Nurse staffing ratios have also been associated with nursing home quality, with higher staffing ratios associated with better outcomes.…”

A National-Level Analysis of the Relationship Between Nursing Home Satisfaction and Quality

“…Lucas et al (2007) survey of New Jersey and Maine NHs found nonchain affiliation positively related with resident satisfaction and negatively related with the presence of a special care unit, while Shippee, Henning-Smith, Gaugler, Held, and Kane (2017) found that chain affiliation was associated with lower family satisfaction in Minnesota NHs, along with higher resident acuity and larger facility size. Findings using Maryland data reinforce these conclusions: You et al (2016) found that larger chain size and for-profit status were associated with lower family satisfaction scores; Ç alkoglu, Christmyer, and Kozlowski (2012) found that higher occupanacy, not-for-profit status, and smaller size were associated with higher family satisfaction scores. Results from Massachusetts indicate a positive association between family satisfaction and government or not-for-profit status, freestanding ownership, smaller facility size, and higher occupancy rates (Li et al, 2013).…”

“…The size of the NH, measured via the number of beds, has also been shown to influence quality and satisfaction (Baldwin, Chenoweth, dela Rama, & Wang, 2017;Ç alkoglu et al, 2012;Kim, 2016;Li et al, 2013;McDonald et al, 2013;Shippee et al, 2015aShippee et al, , 2017You et al, 2016). Highlighting the plausible role of competition within the NH environment on satisfaction, we included the NH occupancy rate, which has been shown to be related to quality and satisfaction (Ç alkoglu et al, 2012;Kim, 2016;Li et al, 2013;McDonald et al, 2013;Mor et al, 2004).…”

“…Highlighting the plausible role of competition within the NH environment on satisfaction, we included the NH occupancy rate, which has been shown to be related to quality and satisfaction (Ç alkoglu et al, 2012;Kim, 2016;Li et al, 2013;McDonald et al, 2013;Mor et al, 2004). Similarly, we included the Herfindahl-Hirschman Index (HHI), which indicates an NH's share of a county's market (with a higher number indicating more market share), and the proportion of a county's population that is 65 or older (Kim, 2016;McDonald et al, 2013;Zhao, 2016).…”