Judge facilities on an individual basis

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A significant and perhaps somewhat controversial piece of research was released this week suggesting that not-for-profit nursing homes offer higher quality care overall than for-profits.

That’s great news for not-for-profits but doesn’t do much to help for-profits, which are still trying to regain their footing from a pretty heavy press and legislative beating over the last couple of years. (Remember the 2007 New York Times story slamming private equity’s negative impact on care and staffing?)

It must be said that this analysis, while it may not please those who work in for-profit homes, does not come as much surprise to those who have been in the field awhile. Not-for-profits generally have a good reputation, and for many it is rightly deserved. Most are mission-driven, often by religious or charitable organizations. Their desire to serve needy people takes precedence over a profit motive. (Of course, they will be quick to point out that they need money, too.)

Also, other studies and reports have come to the same conclusion as the British Medical Journal report. In December, USA Today analyzed the initial rankings of the Five-Star Quality Rating System. It found that more nonprofit nursing homes received five-star ratings and fewer one one-star ratings than for-profit facilities.

We also need to be realistic. For-profits are just that. The term encompasses pleasing shareholders and often generous executive bonuses and salaries. As the study notes, “for-profit facilities have a strong incentive to minimise expenditures.” That might mean lowering staffing at some facilities, for example, which could result in more pressure ulcers, and thus, more deficiencies.

On the flip side, some not-for-profits might have deeper pockets because of generous endowments, which help to fund more staffing and, as a result, better care.

But this most recent analysis is not an indictment of for-profit care. It looked at 82 studies carried out in the U.S. and Canada comparing quality of care in nursing homes dating back to 1965. A large proportion of studies analyzed showed no significant difference in quality of care by ownership. Many had mixed results (some favoring for-profit, some not-for-profit) This may be a result of variables, such as management styles, motivations, and organizational behavior. Also, as the study notes, there is no standard definition of “quality of care.”

As with all studies, this one should be taken with a measure of skepticism. Even study authors note that results should not be read as a blanket statement about the industry. There are still many for-profits that provide wonderful care and many not-for-profits that don’t. As an example, take a mom-and-pop facility that has been in the family for generations. Even though it is for-profit, it maintains a strong commitment to care because of values that have been passed down through the generations.

If there is a take-away, it is that profit should never be the overriding factor when it comes to delivering care to the elderly. We all know, for example, that short-term rehab is a growing trend and helps to draw in needed revenues. Nursing homes grasp for these Medicare dollars, which help to compensate for limited Medicaid payments. But let’s not forget that those vulnerable, long-term care residents are the reason nursing homes exist in the first place.

Bottom line: Serving a vulnerable population has to be mission-driven, whether or not the organization is faith-based. That means providing the best possible care with sufficient staffing levels on a consistent basis.
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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.

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