Families rate independent and nonprofit nursing homes higher on patient experience

By | March 9, 2016

nursing home resident2If you had to find a nursing home for a loved one, would you pick an independent, non-profit facility over a facility that was affiliated with a large, for-profit chain? If you said yes, your instincts are good.

Independent and non-profit nursing homes are rated higher by patients and their families on the experience of their care.

Kai You and colleagues, in an article published ahead of print in Medical Care in January, evaluated nursing homes in Maryland on their patients’ experiences of care using survey responses from family members of long-stay nursing home residents. The survey domains included overall ratings, willingness to recommend, staff and administration, care provided to residents, food and meals, autonomy and resident rights, and physical aspects of the facility. They merged these data with data on nursing facility characteristics.

The authors found that nursing homes affiliated with large- and medium- for-profit chains had significantly lower ratings of family-reported experience with care, both overall and in many subdomains.

The figure below (created for this post using data in the article) shows overall adjusted ratings of care for nursing homes in Maryland by chain affiliation and non-profit status.

NH ratings of care

Source: Author’s analysis of data in You et al. 2016.

Adjusted ratings were based on linear random-effects models that adjusted for nursing home and county characteristics, year dummies, dummies for facility ownership groups, and the clustering of nursing homes over years.

Facilities owned by chain organizations, especially large- and medium-sized for-profit chains, had lower overall satisfaction with care and worse experiences with care in important areas such as staff communication and respect for resident autonomy. Differences in family-reported ratings persist after controlling for important quality indicators as well as other nursing home and market characteristics.

The figure indicates that in Maryland in 2007-10, nursing homes affiliated with large (n>70 facilities) for-profit chains made up about a quarter of the sample, as did independent nonprofit nursing homes. There were no nonprofit nursing homes in medium or large chains in Maryland.

The study is in line with extensive research finding that nursing homes owned by for-profit chains have worse resident and staff outcomes and quality of care. The study’s authors write that “nursing home chains, especially medium and large for-profit chains, may pursue corporate interests over resident needs and employ various strategies to maximize shareholder and investor returns at the expense of resident care.”

The authors acknowledge that they could not eliminate bias due to unobserved factors that are correlated with both chain ownership and their outcome measures. For example, culture change and person-centered care are more likely to be implemented in nonprofit and in independent facilities. Both are associated with improved clinical outcomes, quality of care, quality of life, and other resident and staff outcomes.

Nationally, according to the CDC, the majority (70%) of nursing homes were for-profit in 2014, and 56% were affiliated with chains. Given this and other evidence, agencies should consider adding nursing home for-profit status and chain affiliation (including size) to online resource listings, so that consumers can be empowered to choose wisely. And if you are looking for a care facility for someone you love, check their publicly reported quality data before you commit.

Lisa Lines

Lisa Lines

Health services researcher at RTI International
Lisa M. Lines, PhD, MPH is a health services researcher at RTI International, an independent, non-profit research institute. She is also an Instructor in Quantitative Health Sciences at the University of Massachusetts Medical School. Her research focuses on quality of care, care experiences, and health outcomes among people with chronic illnesses; emergency department utilization; and person-centered care and patient-centered medical homes, among other topics. She is co-editor of TheMedicalCareBlog.com and serves on the Medical Care Editorial Board. She also serves as chair of the APHA Medical Care Section's Health Equity Committee. Views expressed are the author's and do not necessarily reflect those of RTI or UMass Medical School.
Lisa Lines
Lisa Lines

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About Lisa Lines

Lisa M. Lines, PhD, MPH is a health services researcher at RTI International, an independent, non-profit research institute. She is also an Instructor in Quantitative Health Sciences at the University of Massachusetts Medical School. Her research focuses on quality of care, care experiences, and health outcomes among people with chronic illnesses; emergency department utilization; and person-centered care and patient-centered medical homes, among other topics. She is co-editor of TheMedicalCareBlog.com and serves on the Medical Care Editorial Board. She also serves as chair of the APHA Medical Care Section’s Health Equity Committee.

Views expressed are the author’s and do not necessarily reflect those of RTI or UMass Medical School.