For-Profit Status Influences Hospitalization and Mortality Rates in Long-Term Care Facilities

A study by the Institute for Clinical Evaluative Sciences found that for-profit long-term care facilities have a 16% higher death rate for residents within 6 months of admission than non-profit long-term care facilities. The study was published in JAMDA (https://bit.ly/1SitL8z).

Peter Tanuseputro (Bruyere Research Institute, Bruyere Centre of Learning, Research and Innovation in Long-Term Care, Ottawa Hospital, Canada) and his colleagues conducted a retrospective cohort study of new admissions in 640 publicly funded long-term care facilities in Ontario, Canada. Of these, 384 were for-profit institutions, and 256 were non-profit institutions. Among long-term care facilities in Canada, the United States, and the United Kingdom, more than half are managed by for-profit institutions, whereas others are operated by private or public non-profit entities. Although the effect of long-term care facilities’ proprietary status on quality of care has been studied previously, the findings of these studies have been inconsistent. 

For 53,739 residents admitted between 2010 and 2012, the team evaluated the rates of hospital admissions and mortality at 3 months, 6 months, and 12 months after admission. In order to control for possible confounding factors that may have contributed to the inconsistencies seen in previous studies, the researchers applied several exclusions to the patient population and included a variety of factors in their models relating to patient demographics, facility variables, and patient health status.

At the 12-month follow-up, residents in for-profit facilities had a mortality rate of 208 per 1000 person-years (PY), whereas the mortality rate for residents in non-profit facilities was 185 per 1000 PY.

Furthermore, older adults in for-profit facilities were 33% more likely to be hospitalized than those in non-profit facilities. Twelve months after admission, residents in for-profit facilities had a hospitalization rate of 462 per 1000 PY, versus 358 per 1000 PY for residents in non-profit facilities. These findings come at a time when there is an increasing emphasis on reducing hospitalization rates among older adults living in long-term care settings.

The authors propose several possible explanations for the differences found between long-term care facilities with for-profit and non-profit status. For one, it has been suggested that differences in outcomes may be related to non-profit facilities reinvesting funds into patient care, whereas the same funds might be consumed as profit in for-profit care settings. For another, it has been shown that for-profit facilities in Canada, where the study took place, have lower staffing levels. Other explanations proposed by the authors include differences in ties to acute care facilities, the level of specialized care provided, ties to the community, associations with chains or multisite enterprises, and capital funding and fundraising. 

Further study is needed to determine which of these factors, if any, are associated with care quality in for-profit and non-profit long-term care facilities.—Kara Rosania