Which Nursing Homes Offer The Best Care?

This study is a review and meta-analysis of other studies and trials that attempted to compare and contrast the quality of health care services offered by profit-making and non-profit-making nursing homes. This review analyzed 82 studies and concluded, “on average, not-for-profit nursing homes deliver higher quality care than for-profit nursing homes.”

Nursing homes are responsible for providing good quality care and support to patients who are disabled or elderly and are unable to attend to their own needs. Very few studies have attempted to analyze the quality of service provided by these nursing homes. The assessment of nursing homes is of interest to the public as well as policy makers. It is believed that the quality of care differs in profit-making and non-profit-making nursing homes. Nearly two-thirds of the American nursing homes are for-profit organizations, while over half of the health care beds in the United Kingdom belong to independent nursing homes run by profit-making organizations. This review attempted to see if the quality of care differed in the for-profit and not-for-profit nursing homes. The authors speculate that an analysis of previous studies on this subject may yield important information for policy makers, enabling appropriate use of public funds for health care in nursing homes.

This review considered 8,827 studies out of which 956 were found to be appropriate for analysis. Out of these, 82 studies had all the inclusion criteria based on the efficiency of care in nursing homes. These studies were obtained from journal databases like Embase, CINAHL, Medline, HealthStar, and many more. All studies reported from the date of inception of the databases until April 2006 were reviewed. The four most common measures for quality of health care, namely, the quality of staff, rates of bed sores and pressure ulcers among inmates, prevalence of physical restraints, and deficiencies in government regulations were assessed from the available data.

Key findings

  • Of the 82 selected studies, 40 studies showed that non-profit-making nursing homes provided significantly better quality of care when compared to profit-making nursing homes. On the other hand, only three studies showed a contrary result. The remaining studies did not show any significant difference between the two types of nursing homes.
  • Upon evaluation of all the studies, it was found that non-profit homes performed better in two areas of quality assessment, namely, higher quality of staff recruitment and lower rates of bed and pressure sores among the inmates.
  • The difference in the other two measures (the use of physical restraints and deficiencies in following government regulations) was not significant in the case of for-profit and non-profit nursing homes.

Next steps/Shortcomings
According to the authors, “No randomized trials have compared quality of care across nursing home ownership”, and no such study can be expected in the future. Moreover, most of the studies were from the United States, which provides a localized view of the issue. There are no standard measures to assess the quality of care. The measures used in this study were merely based on assumptions of “alternative measures of quality”. The authors suggest further studies that compare the costs of running both types of nursing homes in an attempt to understand the cost-benefit aspects of these health care facilities.

This review shows that there is a lower quality of care in the profit-making nursing homes, when compared to the non-profit ones. However, the authors agree that many studies reviewed show no difference in the quality of care between the two, and therefore, an immediate judgment cannot not be passed against profit-making nursing homes. The government supports both types of facilities with subsidies and funds, and both types of homes face financial difficulties. This may be reflected in the quality of staff recruitment and other aspects of care.  Thus, a further analysis of the cost benefits of these institutions is warranted.

For More Information:
Quality of Care in For-Profit and Not-For-Profit Nursing Homes: Systematic Review and Meta-Analysis
Publication Journal: British Medical Journal, August 2009
By Vikram R Comondore; P J Devereaux
From the University of British Columbia, Vancouver, Canada and McMaster University, Hamilton, Canada

. *FYI Living Lab Reports Are Summaries of the Original Research.

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