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Largest For-Profit Nursing Homes Offer Low Staffing, Poor Care, Study Says

The largest for-profit nursing homes in the nation deliver significantly lower quality of care to their residents because they often have fewer staff nurses than government-owned or non-profit nursing homes, a new study shows.

That’s the finding of a new UCSF-led analysis of quality of care at nursing homes around the country.

This study by the University of California at San Francisco is the first to focus solely on quality and staffing at the nation’s 10 largest for-profit chains. Low nurse staffing levels, like those mentioned in this study, are considered the strongest indicator of poor nursing home quality.

“Poor quality of care is endemic in many nursing homes, but we found that the most serious problems occur in the largest for-profit chains,” said Dr. Charlene Harrington, professor emeritus of sociology and nursing at the UCSF School of Nursing. “The top 10 chains have a strategy of keeping labor costs low to increase profits. They are not making quality a priority.”

The 10 largest for-profit chains operate about 2,000 U.S. nursing homes, controlling about 13 percent of the nation’s nursing home beds.

Nursing home chains have undergone a considerable expansion in recent decades. Some were publicly-traded companies until around the year 2000, when five of the nation’s largest chains went bankrupt. Following ownership changes and restructuring, as well as increases in Medicare payments, the largest chains have now became more financially stable. In fact, some of the largest publicly held chains have now been purchased by private equity investment firms. These firms invest funds received from investors, with whom they share profits and losses.

To measure quality of care, the researchers compared facility deficiencies and staffing levels at the for-profit chains to those at nursing homes operated by five other ownership groups. The 10 largest chains were selected for this study because they are influential in the nursing home industry and are the most successful in terms of market share and growth.

Researchers found that for-profit homes work to keep their costs down by reducing staffing, particularly registered nurse or RN staffing.

The recent 11 percent cuts in Medicare payment rates for nursing home residents may even further jeopardize the safety and health of residents if the chains respond by reducing staffing and wages, Harrington said.

The 10 largest for-profit chains in 2008 were HCR Manor Care, Golden Living, Life Care Centers of America, Kindred Healthcare, Extendicare Health Services, Inc., National Health Care Corporation, Genesis HealthCare Corporation, Sun Health Care Group, Inc., SavaSeniorCare LLC, and Skilled HealthCare, LLC.

These chains had fewer nurse staffing hours than government and non-profit nursing homes between 2003 and 2008 when controlling for other factors. Combined, these companies had the sickest residents, but their total nursing hours were about 30 percent lower than non-profit and government nursing homes. In fact, the top chains were well below the national average for RN and total nurse staffing, and also fell below the minimum nurse staffing recommended by experts.

The 10 largest for-profit chains also were cited for 36 percent more deficiencies and 41 percent more serious deficiencies than the best facilities. These deficiencies include failure to prevent pressure sores, falls, infections, resident weight loss, poor sanitary conditions, resident mistreatment, and other problems that could seriously harm residents.

Researchers also found the four largest for-profit nursing home chains purchased by private equity companies between 2003 and 2008 had even more deficiencies after they were acquired. The study is the first to make the link between worse care following acquisition by private equity companies.

While more study is needed on this subject, researchers say that greater accountability and quality oversight mechanisms would help improve nursing home care in this country, along with good funding incentives and sanctions for poor quality and low staffing.

For more on nursing home issues, see the library of articles by Daytona Beach nursing home injury attorney.



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