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Quality of Care Lower in For-Profit Nursing Homes than in Non-Profits

University of California/Harvard Study Finds Investor-owned Homes Skimp on Nursing, Frequently Cited for Deficient Care

A study published in today's American Journal of Public Health (Full article in Adobe PDF format) finds that investor-owned nursing homes are much more likely to be cited for deficient quality than non-profit homes. The study analyzed data from 1998 government inspections of 13,693 nursing homes, virtually every nursing home in the U.S.

Inspectors cited investor-owned facilities for deficient care 46.5% more frequently than non-profits (and 43.0% more frequently than public nursing homes.) Investor-owned homes also had significantly higher rates of severe quality problems, situations in which patients were actually harmed by poor quality. Quality was particularly poor at facilities owned by nursing home chains.

Nurse staffing was also lower at investor-owned homes. Licensed nurse (Registered Nurse or Licensed Practical Nurse) staffing per patient at investor-owned facilities was 31.7% lower than at non-profits and 22.8% lower than at public facilities; nurses' aide staffing was 11.9% and 16.0% lower respectively.

Almost two-thirds of all U.S. nursing homes are investor-owned, though tax-dollars pay for more than four-fifths of all nursing home bills. Periodic public scandals in the past have raised concerns that for-profit facilities may be skimping on care in order to make a profit, but the UC/Harvard study is the first nationwide study to document that investor-owned homes deliver worse quality care.

The research is the latest of a series of studies documenting that for-profit health providers compromise quality. For instance, investor-owned HMOs are known to deliver lower quality care than non-profits; investor-owned hospitals are more expensive, and have death rates 6% higher than their non-profit counterparts; and investor-owned kidney dialysis clinics have 21% higher death rates than non-profit facilities paid identical amounts.

"Nursing home advocates, discharge planners and the public need to be aware of the lower quality in investor-owned facilities and take this into account when selecting a nursing home." said Professor Charlene Harrington of the University of California, San Francisco.

"When investor-owned chains understaff their facilites and underpay their workers, the chain makes money but quality suffers" said Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard and one of the authors of the study. "For the 1.6 million Americans who reside in nursing homes, the quality of care largely determines the quality of life. Nursing homes care for many people too frail, too sick, and too powerless to choose or even protest their care. It is immoral to put such vulnerable patients at the mercy of profit-hungry firms."

"Our decade-old experiment with market medicine is a failure," said study co-author Dr. David U. Himmelstein of Harvard, who also serves as National Spokesperson for Physicians for a National Health Program. "It's time to end our race to the bottom in health care and implement national health insurance, including universal coverage for high quality long term care."