Accolade For 'Voluntary' Nursing Homes

On average, not-for-profit nursing homes deliver higher quality care than for-profit nursing homes.

This is one of the findings in a new study published this week on the British Medical Journal's website, bmj.com.

However, the authors stress that many factors may influence this relation and more work is needed to explore the impact of profit status on the quality of care delivered.

Concerns about quality of care in nursing home care are widespread.

In the United States, two thirds of nursing homes are for-profit institutions, while in Canada, just over half of nursing homes are in for-profit ownership.

Similarly, in the UK, more than half of healthcare beds belong to independent nursing homes for older people, most of which are operated by for-profit institutions.

So a team of researchers based in Canada analysed the results of 82 studies, spanning 1965 to 2003, comparing quality of care in for-profit and not-for-profit nursing homes. Most of the studies were carried out in the US and Canada.

Differences in study design and quality were taken into account to minimise bias.

Forty studies showed significantly better quality in not-for-profit homes, while three studies favoured quality of care in for-profit homes.

The remaining studies had mixed results suggesting that, although the average effect is clear, there is substantial variation across institutions.

Further analysis suggested that not-for-profit facilities delivered higher quality care than did for-profit facilities for two of the four most frequently used quality measures: more or higher quality staffing and lower pressure ulcer prevalence.

The analysis also favoured not-for-profit homes in the other two measures: use of physical restraint and lower regulatory agency deficiencies. But these results were not statistically significant.

Based on these findings, the authors estimate that nursing home residents in Canada would receive roughly 42,000 more hours of nursing care per day and those in the United States would receive 500,000 more hours of nursing care per day if not-for-profit institutions provided all nursing home care.

Similarly, they estimate that 600 of 7,000 residents with pressure ulcers in Canada, and 7,000 of 80,000 residents with pressure ulcers in the United States are attributable to for-profit ownership.

These findings provide insight into average effects and suggest a trend towards higher quality care in not-for-profit facilities than for-profit homes, write the authors.

Professor Tamara Konetzka from the University of Chicago in an accompanying editorial, pointed out that more data is needed to increase understanding of the association between profit status and the quality of nursing homes.

But she points out that many factors other than profit status have been strongly linked to the quality of nursing home care, and warned that: "If differences in quality between for-profit and not-for-profit nursing homes stem at least in part from differences in revenues rather than mission, eliminating for-profit homes may do little to eliminate differences in quality."

(BMcC/KMcA)