Religious Affiliation May Impact Wrongdoing in Nursing Homes

According to findings published in Management Science, violations of standards of care may be more severe in religiously affiliated (RA) homes since some organizational members are less likely to file complaints. 

Researchers noted that previous studies have not sufficiently considered organizational context when studying the relationship between religion and wrongdoing. The Management Science study was built to investigate the connection between religion and wrongdoing in the context of US nursing homes and potential causation. 

Researchers evaluated Centers for Medicare and Medicaid Services (CMS) data on all recorded violations of standards of care between 2010 and 2015 from 16,101 nursing homes, virtually all nursing homes in the US at the time. Approximately 1.6 million residents and 104,204 violation reports were included in the data set. 
Wrongdoing was defined as acts such as neglect (eg, refusal or failure to provide food, clothing, medicine, shelter, supervision, and medical care) and abuse (eg, slapping, pushing, inappropriate touching, and sexual assault), according to researchers. 

“More than 15% of the nonprofit homes in our data report a religious affiliation in their annual filings,” said researchers. “In these homes, religion is made salient through physical symbols, rituals, and daily interactions with individuals who often share the same faith such as residents, their families, and/or staff members.” 

According to researchers, violations were recorded by inspectors from state agencies during routine inspections or in response to formal complaints. Violations were tagged by type and rated in severity and scope on a 12-point scale. Residual inspector bias was addressed through collecting qualitative evidence on repeat interactions and aggregate data on biases in response to complaints, conducting subsample analyses by state size, and running models on counties with religiously homogeneous populations.

The time between any 2 routine inspections in RA and secular homes was similar in magnitude and statistically identical (381 versus 377 days, respectively; P=.145). However, the time between any 2 complaint-based inspections was significantly longer for RA homes (156 versus 180 days, respectively). RA homes received fewer and less frequent complaint-triggered inspections than secular facilities consistently across the entire range of survival time. 

A positive relationship was found between time and violation severity. The predicted probability of identifying violations of the highest severity was 9.82% for secular facilities and 12.61% for RA facilities. 

“We track this difference to a reduction in the likelihood that organizational members file complaints rather than poorer behaving caretakers or differential treatment by enforcement agents,” said researchers. “Fewer complaints increase the time that religiously affiliated homes operate without monitoring, which allows violations to escalate before they are detected.”

Catholic nursing homes were less likely to experience complaint inspections than other denominations. They also observed similar trends for the number and severity of violations, with Catholic homes showing the most substantial effect. However, multidenominational homes did not show a statistically significant difference compared to secular homes regarding complaint filings.

“Our findings highlight an understudied process in the literature on organizational wrongdoing: Although much attention has been devoted to how inspector bias can lead to incorrect conclusions about the true rates of wrongdoing across organizations, religious affiliation can lead to similarly incorrect conclusions—but through an internal organizational process,” said researchers. 

Reference: 
Mohliver A, Ody-Brasier A. Religious affiliation and wrongdoing: evidence from US nursing homes. Management Science. Published online ahead of print March 21, 2022. doi:10.1287/mnsc.2022.4350