Guest Blog: For-Profits Under Attack
The following is a guest blog from Anthony Cirillo, FACHE, ABC:
The for-profit versus not-for-profit debate - research continues to suggest that higher quality is associated with the not-for-profit sector. In reviewing studies from the last year, consider this. (editors note: Read a column on this: http://long-term-care.advanceweb.com/Columns/Gerotalk/Study-Finds-Largest-For-Profit-Nursing-Home-Chains-Providing-Lesser-Care.aspx)
A study by the University of California at San Francisco research team led by Charlene Harrington, RN, Ph.D., and backed by the Service Employees International Union, suggests that lower levels of nursing staff in large for-profit nursing home chains have resulted in substantially lower quality of care when compared to government-owned or non-profit nursing homes.
Researchers compared staffing levels and facility deficiencies received by the United States' 10 biggest nursing home chains, versus facilities run by five other types of ownership groups. Between 2003 and 2008, the for-profit facilities had fewer nurse "staffing hours," researchers said. The 10 largest nursing home chains received 36 percent more deficiencies from regulators, according to the study. Additionally, the for-profit sites received more deficiencies after being purchased by private equity groups than before the purchases.
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According to the Centers for Medicare and Medicaid Services (CMS), as reported in the American Journal of Infection Control, CMS cites 15 percent of nursing homes each year for deficiencies in infection control. Infections contribute to more than 380,000 deaths annually among nursing home residents, and cost estimates associated with such infections can reach as high as $2 billion.
Researchers analyzed eight years of data, looking for infection control, or F-Tag 441, citations. The number has actually trended upward, increasing from 12.87percent in 2000 to 17.31 percent in 2007, according to the study.
Interestingly enough, researchers say that infections rates correlated strongly with low staffing levels and nursing homes' for-profit status.
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The Center for Medicare Advocacy recently evaluated Special Focus Facilities (SFFs) from the list released by CMS. It concluded that self-reported quality and staffing information from nursing homes categorized as Special Focus Facilities is unreliable and should not be published on Medicare's Nursing Home Compare website.
According to the report, the overwhelming majority of SFFs (45 of 47 facilities, or 96%) are owned on a for-profit basis.
The Center compared the star ratings for a sample of SFFs, evaluating the ratings for health surveys (independent outside reviews), staffing (self-reported), quality measures (self-reported), and composite ratings. The Center hypothesized that SFFs would report high levels of staffing and high quality measures.
All SFFs had low star ratings on health surveys. However, SFFs reported considerably higher nurse staffing and quality measures, resulting in higher star ratings on those two domains than on the health survey domain.
With a move to aging in place and less acute settings, it is only natural that some natural selection take place. I would envision chronic SFFs eventually close as the marketplace demand goes down and consumers become savvier about shopping for care.
Reports like this do not help the industry a whole lot. What baffles me is that I seldom read about the industry's response to the research. And that is particularly baffling when more and more research comes out against for-profit facilities in an industry dominated by them. This is your public relations at stake, your brand. Unfortunately people can poke apart an ad campaign by pointing to the myriad of studies continuing to suggest that for-profit nursing homes have poorer quality. And of course going with that is the unspoken - for-profits only care about the money.
While I do not believe that, remember we are working with perceptions out there. And the long-term care arena has a huge image problem especially in the for-profit sector.
Anthony Cirillo is the about.com expert in assisted living. A speaker, health care consultant, senior advocate and blogger, he consults with long-term care facilities and is available for management retreats and association keynotes. He is the author of "Who Moved My Dentures?" His company, Fast Forward Consulting empowers organizations to change the healthcare experience and leverage it in their marketing. For more information go to More at www.4wardfast.com and www.anthonycirillo.com.