Nonprofit Nursing Homes Provide Better Care, Major Study Finds

A
major new statistical review of 82 individual research studies has
revealed that nonprofit nursing homes deliver, on average, higher
quality care than for-profit nursing homes. The findings could have a
bearing on the present debate about the role of for-profit firms in
U.S. health reform.

"The
results are unequivocal and completely consistent with other studies
comparing for-profit versus nonprofit care," said Dr. Gordon Guyatt,
senior author of the study, professor of medicine at McMaster
University in Hamilton, Canada, and a world leader in "evidence-based
medicine," a term he coined. The study was published in the online
edition of the British Medical Journal earlier this month.

The
authors' systematic review compared quality-of-care measurements in 82
individual studies that collected data from 1965 to 2003 involving tens
of thousands of nursing homes, mostly in the United States.

In
40 of the 82 studies, all statistically significant comparisons favored
nonprofit facilities. In three studies, all significant comparisons
favored for-profit facilities. The remaining studies had less
consistent findings.

The
authors' meta-analysis, i.e. their integration and statistical analysis
of the data from the multiple studies, shows that nonprofit facilities
delivered higher quality care than for-profit facilities for two of the
four most frequently reported quality measures: (1) more or higher
quality staffing and (2) less prevalence of pressure ulcers, sometimes
called bedsores.

The
results also suggest better performance of nonprofit homes in two other
quality measures: less frequent use of physical restraints and fewer
noted deficiencies (quality violations) in governmental regulatory
assessments.

"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," said Guyatt.
"For-profit providers cut corners to ensure shareholders achieve their
expected return on investment."

About
1.5 million people reside in nearly 16,000 nursing homes in the United
States, and more than 3 million Americans will spend at least some time
in a nursing home this year, according to the U.S. Centers for Medicare
and Medicaid Services. About two-thirds of U.S. nursing home residents
live in for-profit facilities.

The
findings have significant patient-care implications. For example, the
study suggests that of the estimated 80,000 U.S. nursing home residents
who presently have bedsores, 7,000 of these cases are attributable to
for-profit ownership. Similarly, the results suggest U.S. residents
would receive about 500,000 more hours of nursing care per day if
nonprofit institutions replaced for-profit nursing homes.

While
most of the data in the studies are from U.S. nursing homes, data from
Canada and Taiwan were also reviewed. Results were consistent over time.

The
authors note that the results are entirely consistent with other
studies. Systematic reviews of the evidence have previously shown
higher death rates in for-profit versus nonprofit hospitals, and in
for-profit versus nonprofit dialysis facilities. Such reviews have also
shown higher costs in for-profit hospitals. Studies of outpatient care
have shown higher quality of care in not-for-profit settings.

"Our
results should raise serious concerns about for-profit care, whether in
nursing homes, hospitals, surgi-centers, or other outpatient
facilities," Guyatt said. "It is time to base health care policy on
evidence, not ideology."

*******

"Quality
of care in for-profit and not-for-profit nursing homes: systematic
review and meta-analysis," Vikram R Comondore, P J Devereaux, Qi Zhou,
Samuel B Stone, Jason W Busse, Nikila C Ravindran, Karen E Burns, Ted
Haines, Bernadette Stringer, Deborah J Cook, Stephen D Walter, Terrence
Sullivan, Otavio Berwanger, Mohit Bhandari, Sarfaraz Banglawala, John N
Lavis, Brad Petrisor, Holger Schunemann, Katie Walsh, Neera Bhatnagar,
and Gordon H Guyatt. BMJ 2009;339:b2732, doi: 10.1136/bmj.b2732, Aug.
4, 2009.

A copy of the study can be found here: www.pnhp.org/nursing_home