Study: Nonprofit homes give better care

A new statistical review of 82 research studies, mostly United States-based, suggests that nonprofit nursing homes deliver, on average, higher-quality care than for-profit nursing homes – but some in the industry are questioning the findings and the authors’ motivations.
The study, published this month in the British Medical Journal’s online edition, compared quality-of-care measurements in studies based on data from 1965 to 2003, involving tens of thousands of nursing homes, mostly in the United States but also in Canada and Taiwan.
In 40 studies, all statistically significant comparisons favored nonprofit facilities. In three, they favored for-profits. The rest didn’t clearly favor either.
Overall, the authors found, nonprofits scored better on two of the four most frequently reported quality measures: staffing and prevalence of pressure ulcers or bedsores. Nonprofit homes also tended to do better on use of physical restraints and on the number of deficiencies found during government inspections.
“The results are unequivocal and completely consistent with other studies comparing for-profit versus nonprofit care,” said Dr. Gordon Guyatt, senior author and professor of medicine at McMaster University in Hamilton, Canada.
“The reason patients’ quality of care is inferior in for-profit nursing homes is that administrators must spend 10 percent to 15 percent of revenues satisfying shareholders and paying taxes,” Guyatt added. “For-profit providers cut corners to ensure shareholders achieve their expected return on investment.”
Noting that about 1.5 million people live in the nearly 16,000 nursing homes in the United States, and more than 3 million will spend at least some time in a nursing home this year, the study suggests that thousands of adverse events could be avoided if all homes were nonprofit.
The study also draws connections to research on other health care settings. “Our results should raise serious concerns about for-profit care, whether in nursing homes, hospitals, surgi-centers, or other outpatient facilities,” Guyatt said.
Asked for comment, James Nyberg, director of the Rhode Island Association of Facilities and Services for the Aging, which represents nonprofit providers, said the review’s findings “validate the efforts of mission-driven, not-for-profit providers, who invest their resources in enhancing services and staff, improving facilities, and responding to community needs.”
Nyberg added that nonprofits tend to have higher staffing levels, “which is considered a good proxy for quality,” and the study “bears that out.”
But Virginia Burke, executive director of the Rhode Island Health Care Association, which represents primarily for-profit providers, questioned the study’s credibility, saying it’s “not surprising” that a review performed by advocates for nonprofit health care came out like this.
The data used by the studies reviewed is also too old to reflect quality improvement efforts “across the entire sector” in recent years, Burke noted, and more important, the majority of the studies did not actually show a significant difference in quality based on ownership.
“Whatever the validity of the study, Rhode Islanders can rest assured that both nonprofit and for-profit homes in Rhode Island provide excellent quality of care,” Burke added. “Most of the so-called ‘for-profit’ nursing homes in our state are in fact family-owned and operated facilities, run by the adult children of the people who founded them.”
More than 80 percent of Rhode Island’s nursing homes are for-profit, Burke concluded, and yet the state’s facilities “routinely score equal to or better than national averages on publicly reported quality measures, according to the [U.S.] Center for Medicare & Medicaid Services.”
The full study can be downloaded, free of charge, on the British Journal of Medicine Web site.