Study Finds Top Nursing Home Chains' Focus on Low Labor Costs Reduces Care Quality

Nursing homes are notoriously understaffed, but a new analysis reveals that the largest for-profit facilities typically maintain staffing levels nearly one-third lower than non-profit and government-owned nursing homes, resulting in a significantly lower quality of care.

The study, led by the University of California San Francisco (UCSF), looked at the relationship between staffing and quality of care at the 10 largest for-profit nursing home chains. 

“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 lead author Charlene Harrington, RN, PhD, 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.”

Although the top chains had the sickest residents, their total nursing hours were 30 percent lower than non-profit and government nursing homes, the UCSF study found. Moreover, the major chains were well below the national average for registered nurse (RN) and total nurse staffing, and below the minimum nurse staffing recommended by experts.

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

The study also found that care goes downhill when a for-profit chain is acquired by a private equity company.  Recently, some of the largest publicly held chains have been purchased by private equity investment firms, in which investors share profits and losses with the firm.  The four largest for-profit nursing home chains purchased by private equity companies between 2003 and 2008 had more deficiencies after being acquired, according to the UCSF researchers.

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

In 2007, ElderLawAnswers reported on another study, also by Dr. Harrington, that found that raising minimum staffing requirements has a direct impact on the quality of care nursing home residents receive.

For more on the most recent UCSF study, click here.

For more on nursing homes, click here.