Does Nursing Home Ownership Change Affect Family Ratings on Experience with Care?

Abstract

Person-centeredness may suffer in NHs with recent ownership changes. This study identifies associations between ownership change and reported care experiences, important measures of person-centered care, for long-term residents in Maryland NHs. Care experience measures and ownership change data were collected from Maryland Health Care Commission reports, which reported data on 220 Maryland NHs from 2011–2012. Facility and market covariates were obtained from 2011 NH Compare and Area Health Resource Files. Linear regression was used to examine whether ownership change in 2011 was associated with lower care experience ratings reported during April–June 2012. Dependent variables were overall care rating (scale 1–10), percent of respondents answering that they would recommend the NH, and assessments of five care and resident life domains (scale 1–4). Care experiences reported in 2012 were high; however, after controlling for covariates, ownership change was associated with significant decreases in 6 out of 7 measures, including a 0.39-point decrease in overall care rating (P=0.001). NH managers and policymakers should consider strategies to improve patient-centeredness post-ownership change.

Racial/Ethnic Disparities in Nursing Home Quality of Life Deficiencies, 2001 to 2011

“…Commonly examined NH quality measures, such as pressure ulcer rate and staffing intensity and mix, may not provide a complete representation of residents’ welfare and QoL. However, non-clinical aspects of NH performance, such as NH environment, programming, and resident autonomy, may be more indicative of experience with NH care from the perspective of residents and families (Campbell, Li, & Li, 2015). To our knowledge, no previous studies have examined racial/ethnic disparities in NH QoL, measuring QoL as the average number of QoL deficiencies.…”

“…Although the QoL section of the NH inspection covers multiple domains of resident life and care (Harrington et al, 2002; Harrington et al, 2000), examining QoL measured by resident and/or family reports may yield more direct measures from residents’ and families’ perspectives. Prior studies have examined resident and family reports in individual states (Campbell et al, 2015; Li et al, 2013), and have found racial/ethnic disparities in QoL (Li et al, 2014). Future studies could analyze multi-state trends in racial/ethnic disparities in QoL using data collected from NH residents or family members to better inform state policies.…”

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

“…Staffing is measured via five types of staffing: hours per resident day for RNs , LPNs , and certified nursing assistants (CNAs), occupational therapy hours per resident day (OT HPRD), and physical therapy hours per resident day (PT HPRD). Profit status has been associated with NH quality outcomes (Comondore et al, 2009; Hillmer, Wodchis, Gill, Anderson, & Rochon, 2005; You et al, 2016) and consumer satisfaction (Çalkoğlu et al, 2012; Campbell et al, 2015; Li et al, 2013; You et al, 2016), as have chain status (Grabowski et al, 2016; Li et al, 2013; Lucas et al, 2007; McDonald et al, 2013; Shippee et al, 2017; You et al, 2016) and payer mix (Çalkoğlu et al, 2012; Li et al, 2013; Mor, Zinn, Angelelli, Teno, & Miller, 2004; Shippee et al, 2015a). Payer mix is measured using the proportion of residents paid for by Medicaid and the proportion of residents paid for by Medicare .…”

“…Beyond quality, factors found to predict higher satisfaction with NH care include not-for-profit status (Çalkoğlu et al, 2012; Li et al, 2013), smaller size (Çalkoğlu et al, 2012; Li et al, 2013), independent (non-chain-affiliated) ownership (Li et al, 2013; Lucas et al, 2007), higher occupancy (Çalkoğlu et al, 2012; Li et al, 2013), having a family council (Lucas et al, 2007), higher proportion of Medicaid days (Çalkoğlu et al, 2012), and lower proportion of Medicare residents (Li et al, 2013). Alternatively, for-profit ownership (You et al, 2016), larger size (Shippee et al, 2017), chain affiliation (Shippee et al, 2017; You et al, 2016), change in facility ownership (Campbell, Li, & Li, 2015), higher resident acuity (Shippee et al, 2017), and presence of a special care unit (Lucas et al, 2007) have been negatively associated with lower satisfaction.…”

Quality effects of home acquisitions in residential aged care

“…Past research, primarily conducted in the United States, has shown that changes in ownership lead to a reduction in registered nurse staffing, 4,15,16 an increase in deficiency citations 4,6,17 and pressure ulcers, 6 and a decline in reported care experiences. 18 However, the effects of acquisitions are not straightforward, with studies showing that postacquisition outcomes also depend on the characteristics of the acquiring provider, including its profit status 19 and overall 'chain' quality. 6 Such results suggest that the consequences of acquisition activity are contingent on the acquiring provider.…”