Nursing Home Profit Status and Quality of Care: Is There Any Evidence of an Association?

Hillmer, Michael; Wodchis, Walter P.; Gill, Sudeep S.; Anderson, Geoffrey M.; Rochon, Paula A.

doi:10.1177/1077558704273769

Cited by 246 publications

(200 citation statements)

References 57 publications

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“…Although Hillmer et al (2005) concluded that FP nursing home status was often associated with reduced quality of care across many important indicators, these data do not provide definitive evidence that FP status is associated, either negatively or positively, with quality of home care.…”

Section: Discussionmentioning

confidence: 43%

“…However, some research has been carried out in the LTC and acute care sectors exploring the relationship between quality of care and staffing levels (Porell & Caro, 1998;Zinn, Aaronson, & Rosko, 1993;Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2002), the size of the organization (Zinn et al, 1993;Porell & Caro, 1998;Teare, Hirdes, Ziraldo, Proctor, & Nenadovic, 2000), for-profit (FP) versus notfor-profit status (NFP) (Hillmer, Wodchis, Gill, Anderson, & Rochon, 2005) and accreditation results (Miller et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

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The Relationship Between Agency Characteristics and Quality of Home Care

Dalby

Hirdes

2008

Home Health Care Services Quarterly

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ABSTRACT.Background. This project assessed the relationship between home care quality indicators (HCQIs) and agency characteristics.Methods. Twelve agencies completed a mailed survey on a variety of characteristics, including size of their caseload and for-profit (FP) status of contracted service providers. The HCQIs were derived from standardized assessments completed voluntarily for home care clients in Ontario and in Manitoba, Canada.Results. The authors wish to thank the participating home care organizations who were instrumental in data collection. They gratefully acknowledge Dr. Brant E. Fries who provided expert guidance during earlier phases of this project. They also acknowledge the financial support of the following agencies: Wilfrid Laurier University Conclusion. These data represent unique information on home care quality and organizational characteristics in Canada. The question remains as to how best to use HCQI data to inform practice in an era of limited resources and increasing caseloads.

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Section: Discussionmentioning

confidence: 43%

Section: Introductionmentioning

confidence: 99%

The Relationship Between Agency Characteristics and Quality of Home Care

Dalby

Hirdes

2008

Home Health Care Services Quarterly

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“…Although there is a substantial body of published research supporting the measurement of staffing as a recognized "structural" indicator of nursing home quality, 3,4 we were careful in our article to also make this point. We hope that our study will encourage further Canadian research on this question.…”

Section: Ed Helfrichmentioning

confidence: 99%

Staffing levels for long-term care

McGregor¹

2005

Canadian Medical Association Journal

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reported as 3.41 hours per residentday, 1 but the funding model would provide only 2.83 hours of direct care. Furthermore, facilities are usually unable to staff to 100% of the funding formula. Although it is probably true that these long-term care facilities would like to be able to staff at the "essential staffing levels" on file with the Labour Relations Board, these values do not reflect actual staffing levels. One possible explanation for the discrepancy is that McGregor and associates used data for paid hours per resident-day rather than worked hours. Paid hours include vacation time, statutory holidays and sick leave and are therefore significantly higher than worked hours, which reflect hands-on care.Given that the validity and accuracy of the hours of care being delivered are questionable, the resulting interpretation and conclusions of the article are similarly debatable. If valid conclusions are to be drawn regarding the overall impact of staffing, staffing levels must be tied directly to outcomes and to client and family satisfaction levels. The level of staffing is obviously a critical factor in quality of care, but other factors such as experience, training, productivity and innovation can be equally important.We believe that the major determinant of differences in staffing levels in private and nonprofit facilities relates to inconsistencies in funding. Nonetheless, excellent services are provided in both sectors, and the provincial ministry of health and the regional health authorities have not identified any differences in quality of care between notfor-profit and for-profit facilities. 2 At the time of our study each facility was receiving a global budget and could decide how to allocate the money among staffing, administration and property costs. Our findings suggest that, with the same funding from government, not-for-profit facilities decided to allocate more of their resources to staffing than did for-profit facilities. Ed HelfrichIn addition, the funding guideline of 2.83 staff hours per resident-day applies only to "intermediate care III" residents. The same guidelines suggest 3.1 hours per resident-day for more debilitated "extended care" residents. These latter residents would partly account for the higher average staffing hours for this facility designation, as would the decision of not-for-profit facilities to put relatively more money into staffing.Helfrich speculates that we might have used data for paid rather than worked hours. The staffing levels obtained from the BC Labour Relations Board represent counts of full-time and part-time staff positions, and the expectation is that people are replaced by casual staff for vacation and sick time. In addition, all facilities operated under a master contract with the same wages and benefits. We have no reason to believe that for-profit facilities were less likely than not-for-profit ones to replace people on sick leave or vacation.Finally, Helfrich makes the point that if valid conclusions are to be drawn about the overall impact of staff...

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“…Driven by profit maximizing, for-profit nursing homes have been shown to provide poorer quality compared to non-profit nursing homes [34][35][36][37].…”

Section: Evidence Of Low Quality In Nursing Homes and Changes In Qualmentioning

confidence: 99%

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

Xing¹,

Mukamel²,

Glance³

et al. 2016

WHM

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2013ii Biographical SketchThe author was born in Shanghai, China. She attended Shanghai Second Medical This dissertation provides evidence that linking Medicaid reimbursement rate to each NH's own expenditures and incentivizing NHs to invest in direct care were effective ways in achieving quality improvement. Refinements of current Medi-Cal reimbursement policy might be needed to encourage NHs to make larger investments. However, maximizing NHs' spending on direct care cannot be relied on as the only policy strategy to improve quality of care. vii Contributors and Funding SourcesThis work was supervised by a dissertation committee consisting of Professors

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Nursing Home Profit Status and Quality of Care: Is There Any Evidence of an Association?

Cited by 246 publications

References 57 publications

The Relationship Between Agency Characteristics and Quality of Home Care

The Relationship Between Agency Characteristics and Quality of Home Care

Staffing levels for long-term care

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

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