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For-Profit Nursing Homes Have Low Staffing and Poor Quality of Care

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Main Category: Nursing / Midwifery
Also Included In: Seniors / Aging
Article Date: 01 Dec 2011 - 8:00 PST

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According to a study published online in advance of print publication in Health Services Research, the largest for-profit nursing homes in the nation deliver considerably lower quality of care as they often have fewer staff nurses compared with non-profit and government-owned nursing homes.

The study, led by University of California, San Francisco (UCSF), of care at nursing homes around the nation, is the first to focus only on staffing and quality at the 10 largest for-profit chains.

First author Charlene Harrington, RN, PhD, professor emeritus of sociology and nursing at the UCSF School of Nursing. Harrington also is director of the UCSF National Center for Personal Assistance Services, explained:

"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. The top 10 chains have a strategy of keeping labor costs low to increase profits. They are not making quality a priority."

It is believed that low nurse staffing levels are the strongest predictor of poor nursing home quality.

In the U.S., the ten largest for-profit chains run approximately 2,000 nursing homes, controlling around 13% of nursing home beds in the nation.

Nursing home chains have undergone a significant expansion in recent decades. Several chains were publicly-traded companies until the early 2000s, when five of the largest chains in the nation went bankrupt. The largest nursing home chains became more financially stable after increases in Medicare payments as well as restructuring and ownership changes. More recently, private equity investment firms, which invest funds received from investors, with whom they share profits and losses, purchased some of the largest publicly held chains.

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

The team observed that for-profit nursing care homes aim to keep their expenses down by reducing staffing, especially RN staffing.

Harrington, stated:

"Recent Medicare cuts in payment rates for nursing home residents - by 11 percent in October, 2011 - may further jeopardize the health and safety of residents if the chains respond by reducing staffing and wages."

In 2008, the 10 largest for-profit nursing home chains were:HCR Manor Care Life Care Centers of America Golden Living Genesis HealthCare Corporation Kindred Healthcare SavaSeniorCare, LLC Sun Health Care Group, Inc. National Health Care Corporation Skilled HealthCare, LLC Extendicare Health Services, Inc. From 2003 to 2008, for-profit chains had fewer nurse "staffing hours" compared to non-profit and government nursing homes when controlling for other factors. Collectively, total for-profit nursing hours were 30% lower than government and non-profit nursing homes, and these companies also had the sickest residents. Furthermore, the top nursing home chains were significantly below the national average for RN and total nurse staffing, as well as below the minimum nurse staffing advised by experts.

Compared with the best nursing homes, the 10 largest for-profit chains were cited for 41% more serious deficiencies and 36% more deficiencies. Deficiencies include failure to prevent:falls infections resident weight loss pressure sores poor sanitary conditions resident mistreatment and other issues that could considerably harm residents In addition, the investigation discovered that the four largest for-profit chains had more deficiencies after being purchased by private equity companies between 2003 and 2008. This investigation is the first to associate poor care after purchase by private equity companies.

According to the researchers, more studies should be carried out. They state that greater accountability and quality oversight mechanisms would help enhance nursing home care, together with effective funding incentives and sanctions for low staffing and poor quality.

Written by Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Additional References Citations Visit our nursing / midwifery section for the latest news on this subject. Health Services Research

Source: University of California, San Francisco (UCSF) Please use one of the following formats to cite this article in your essay, paper or report:

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Grace Rattue. "For-Profit Nursing Homes Have Low Staffing and Poor Quality of Care." Medical News Today. MediLexicon, Intl., 1 Dec. 2011. Web.
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Alliance Of Community Health Plans Report Demonstrates That Enhanced Services And Higher Quality Benefits Lead To Improved Health

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Community health plans are partnering with physician practices to initiate a range of care management programs for people living with chronic diseases; these programs have resulted in decreased emergency room (ER) use, improved health and lower costs. The findings, released by the Alliance of Community Health Plans (ACHP), are part of a report that is a comprehensive look at the way community health plans partner with providers to improve care.

Care management is the coordination of care and services for chronically ill patients who require complex, one-on-one and personalized care, and is emerging as a foundation of patient-centered medical care. At many ACHP plans, a plan-employed care manager works with a medical practice to coordinate services for patients living with long-term, chronic diseases, through activities such as patient education, referral to community resources and agencies, help navigating health care systems and coordination of information among multiple providers. Innovative health plans, including Geisinger Health Plan, Group Health Cooperative and Independent Health have launched care management initiatives in partnership with medical practices, resulting in improved patient experiences.

"Improving how we care for those living with chronic disease is a national priority and requires that we understand not only the role physicians and practices play, but also how health plans can help advance and integrate care," said ACHP President and CEO Patricia Smith. "With this report, we demonstrate the critical role community based health plans play as a partner in improving the delivery system."

ACHP also found significant cost savings when reviewing results from its members' care management programs, primarily due to prevention of avoidable hospitalizations and ER visits. Between January and July of this year, for example, Group Health Cooperative reported total cost savings of more than $2.5 million for patients in its case management programs.

In this report, which notes the evolution from disease management to care management approaches that address the "whole person" including social, environmental or financial barriers to good health, ACHP focused on five key themes that could be adapted more broadly to replicate the positive results found in the care management work of community health plans: Physician Partnerships. A plan-employed nurse working within a provider's practice - whether a plan-affiliated or networked practice - allows patients to view the nurse more as an extension of the physician, therefore improving the patient's experience of truly coordinated care. Face-to-Face Encounters. Personal meetings with a care manager can be used to confirm a doctor's instructions, answer medication questions or learn how to use a medical device. Multidisciplinary Teams. Involving social workers, geriatricians and others in a care management program can help patients and families access specialized services they need. Appropriate Use of Technology. Technologies can increase communication with a patient or speed the delivery of health information to a care manager. This enables a more seamless support system for patients seeing a range of providers or accessing multiple services. Community Mindedness. Familiarity with their local communities helps health plan nurses connect patients to community based organizations that can provide, for example, necessary nutrition, housing, financial, social and home health services. ACHP released its care management report along with a companion Care Management Handbook for health plans looking for greater detail on integrating care management programs. The care management documents are part of a new ACHP series on delivery system reforms, Health Plan Innovations in Patient-Centered Care. The series looks to fill the existing gap in the literature when it comes to identifying ways community based health plans can partner with medical practices and communities to keep patient needs front and center as well as deliver high-value care. Papers on the role of health plans in innovative primary care delivery and transitions of care will follow this first installment on care management.

"The right care and high quality benefits can yield healthier, more satisfied patients; further, enhanced care management services offer the potential of reduced costs" Smith said. "In an era of tight budgets, people think that the only way to reduce costs is to trim services, but our analysis of community based health plans providing care management finds this is not the case."

Additional References Citations Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our primary care / general practice section for the latest news on this subject. Alliance of Community Health Plans Please use one of the following formats to cite this article in your essay, paper or report:

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Alliance of Community Health Plans. "Alliance Of Community Health Plans Report Demonstrates That Enhanced Services And Higher Quality Benefits Lead To Improved Health." Medical News Today. MediLexicon, Intl., 1 Dec. 2011. Web.
1 Dec. 2011. APA
Alliance of Community Health Plans. (2011, December 1). "Alliance Of Community Health Plans Report Demonstrates That Enhanced Services And Higher Quality Benefits Lead To Improved Health." Medical News Today. Retrieved from
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Physical Environment, Workgroup Cohesion Play Significant Roles In Nurses' Ratings Of Quality Of Patient Care

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Article Date: 01 Dec 2011 - 1:00 PST

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While nurse-to-patient ratios are widely recognized as an important factor in determining the quality of patient care, those ratios are not always easy to change without significant cost and investment of resources. What's more, the projected nursing shortage will make it even more difficult for hospitals to increase nurse staffing. A study published in the current issue of Health Care Management Review indicates that there are other aspects of registered nurses' (RNs) work environments that RNs perceive can also have a significant impact on the quality of care they deliver. In order of influence, those factors are: physical work environment, workgroup cohesion, nurse-physician relations, procedural justice and job satisfaction. Nurses' ratings of patient care quality were also higher in hospitals with Magnet® recognition programs, and lower in work settings with greater organizational constraints such as lack of equipment and supplies.

Maja Djukic, PhD, RN, assistant professor at the New York University College of Nursing (NYUCN); Christine Kovner, PhD, RN, FAAN, professor at NYUCN; Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo; Farida Fatehi, BDS, MS, junior research analyst at the New York University College of Dentistry (NYUCD); and Daniel Cline, MSN, RN, CRNP, PhD candidate, and the John A. Hartford Foundation Building Academic Geriatric Nursing Capacity scholar, at NYUCN, were the investigators for the published study. The study is based on a 98-question survey of 1,226 RNs, which is part of RN Work Project, a nationwide, 10-year longitudinal survey of RNs begun in 2006 by Kovner and Brewer, and supported by a grant from the Robert Wood Johnson Foundation.

"There has been a great deal of research into the impact of nurse staffing on patient care, but we know that increasing nurse-to-patient ratios isn't always possible," said Djukic. "What we found in our study is that hospital administrators can improve a variety of work environment factors that are also likely to improve the quality of patient care, without having to change nurse-to-patient ratios. Improvements need to be strategic, because our work shows that the value of enhancing work environment varies across different factors."

For example, the researchers found that Magnet recognition has nearly the same impact on nurses' ratings of patient care quality as workgroup cohesion, but investing in workgroup cohesion is significantly less costly and complicated than applying for and earning Magnet recognition. Additionally, improvements in physical work environment are likely to yield a greater benefit for quality of patient care, as perceived by RNs, than improvements in nurse-physician relations. Then again, implementing a team building program is likely to be less costly than remodeling a hospital unit. Nonetheless, if a hospital is planning to remodel, incorporating RNs' preferences into the physical environment design could result in changes that improve the quality of patient care.

"Health care managers need to think about how they can best redesign RNs' work environments to promote high quality patient care," said Kovner. "They need to examine their resources and determine which changes are possible and which will have the most impact on improving patient care."

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Infection)OsteopathyOsteoporosisOtitis Externa (Swimmer's Ear)Ovarian CancerOvarian CystPaget's Disease (Of Bone)PainPainful Intercourse (Dyspareunia)Pancreatic CancerPancreatitis (acute)Pancreatitis (chronic)Panic AttacksParanoid SchizophreniaParasitesParkinson's DiseasePelvic Inflammatory DiseasePeptic UlcersPericarditisPeriod PainsPeripheral Artery Disease (PAD)Personality DisordersPimplesPinworms (Threadworms)PleurisyPneumococcal DiseasePneumoniaPolioPost Traumatic Stress Disorder (PTSD)Postherpetic NeuralgiaPostpartum DepressionPrader-Willi SyndromePremature EjaculationPrimary Sclerosing CholangitisProgeriaProstate CancerPsoriasisPsoriasisPulmonary Edema (Oedema)Pulmonary EmbolismQ FeverRabiesRadiation Sickness (Radiation Poisoning)Ramsay Hunt SyndromeRaynaud's DiseaseRectocele (Proctocele)Repetitive Strain Injury (RSI)Restless Legs SyndromeRheumatic FeverRheumatoid ArthritisRhinitis, Non-AllergicRicketsRingwormRosaceaRubellaRuptured SpleenSalivary Gland CancerSalmonellaSARSScabiesScarlet Fever (Scarlatina)Schistosomiasis (Bilharzia)Schizoaffective DisorderSchizophreniaSciaticaSclerodermaScoliosisScurvySeasonal Affective DisorderSexual Addiction (Nymphomania)ShinglesShort Stature (Dwarfism)SinusitisSjogren's SyndromeSkin Cancer / MelanomaSlapped Cheek SyndromeSocial Anxiety DisorderSpina BifidaSpinal Muscular AtrophySquint (Strabismus)StammeringStrep Throat / Sore ThroatStressStress IncontinenceStrokeStye (Hordeolum)Subarachnoid HemorrhageSuicidal ThoughtsSwine FluSyphilisTachycardia (Fast Heart Beat)Tapeworms (Cestodes)Teeth Grinding (Bruxism)Tendinitis (Tendonitis)Testicular CancerTesticular TorsionTetanusThyroid CancerThyroid NodulesTinnitusTiredness / FatigueTobacco Smoke ToxinsTonsillitisTourette SyndromeToxic Shock Syndrome (TSS)Transient Ischemic Attacktransient ischemic attackTraumatic Brain Injury (TBI)Trigeminal NeuralgiaTriple X SyndromeTuberculosisTurner SyndromeTyphoidUlcerative ColitisUmbilical HerniaUrinary Tract Infection (UTI)UveitisVaculitis (Angiitis)Vaginal CancerVaginismusVaginitisValley Fever (Coccidioidomycosis)VaricoceleVaricose Eczema (Stasis Dermatitis)Ventricular FibrillationVertigoVesicoureteral Reflux (VUR)Vitamin B12 DeficiencyVocal Cord Paresis (Paralysis)Von Willebrand DiseaseVulvar Cancer (Vulval Cancer)VulvodyniaWartsWater On The Knee (Knee Effusion)Water Retention (Fluid Retention)Wegener's GranulomatosisWernicke-Korsakoff SyndromeWest Nile Virus (WNV)Wheat AllergyWhipple's DiseaseWilliams SyndromeWilms’ Tumor (Nephroblastoma)Wolff-Parkinson-White SyndromeYellow FeverYipsZollinger-Ellison Syndrome

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