The higher adjusted hospitalization rates in FP versus NP facilities is consistent with previous research from U.S. authors. However, the superior performance by the NP sector is driven by NP-owned facilities connected to a hospital or health authority, or that had more than one site of operation.

ResearchRecherche N nursing homes provide long-term housing, support and direct care to members of the community who are unable to function independently because of medical, physical and cognitive disabilities. Although only a small proportion of older Canadians reside in nursing homes (18% of those ≥ 80 years), the majority (81%) of long-term care residents are frail elderly people over the age of 65.1 Government-funded long-term care in Canada has been provided for many years by a mix of not-for-profit (nonproprietary) and for-profit (proprietary) facilities. The ratio of this mix varies greatly by province. For example, in Ontario 52% of publicly funded nursing homes are for-profit, as compared with 15% in Manitoba. 2Previous studies from the United States have shown that having more direct-care personnel is associated with better care in nursing homes.3-7 Specifically, higher numbers of registered-nurse hours per resident-day have been associated with fewer violations of care standards 4 and improved functional ability of residents.7 Schnelle and colleagues examined 21 nursing homes in California and found that the homes with the highest number of nurse aides performed significantly better in 13 of 16 quality-of-care measures than the homes with fewer nurse aides. 6 Although there has been little research on staffing levels and nursing home care in other countries, health policy-makers in the United Kingdom 8 and Australia 9 have begun to call for greater accountability for public resources spent in this area.The American literature has also shown that, compared with for-profit nursing homes, not-for-profit facilities have higher direct-care staffing levels 4 and lower staff turnover rates.10,11 However, the majority of nursing home care in the United States is delivered by the for-profit sector, whereas in Canada the not-for-profit sector constitutes the majority. This may result in a difference in the informal benchmarks for staffing levels between the 2 countries. There also may be a wider variation in wages and working conditions among nursing homes in the United States, which potentially confounds the comparison between for-profit and not-for-profit facilities.We compared staffing levels of nursing and support staff in publicly funded long-term care facilities by ownership type (not-for-profit v. for-profit) in British Columbia at a time when the majority of publicly funded not-for-profit and for-profit facilities employed a unionized labour force with standardized wages and benefits set by a master collective agreement.In British Columbia, approximately 70% of publicly funded nursing homes are nonproprietary (not-for-profit) Currently there is a lot of debate about the advantages and disadvantages of for-profit health care delivery. We examined staffing ratios for direct-care and support staff in publicly funded not-for-profit and for-profit nursing homes in British Columbia. Methods: We obtained staffing data for 167 long-term care facilities and linked these to the type of facility and ownership of t...

This study examined how nursing home facility ownership and organizational characteristics relate to emergency department (ED) transfer rates. The sample included a retrospective cohort of nursing home residents in the Vancouver Coastal Health region (n = 13,140). Rates of ED transfers were compared between nursing home ownership types. Administrative data were further linked to survey-derived data of facility organizational characteristics for exploratory analysis. Crude ED transfer rates (transfers/100 resident years) were 69, 70, and 51, respectively, in for-profit, non-profit, and publicly owned facilities. Controlling for sex and age, public ownership was associated with lower ED transfer rates compared to for-profit and non-profit ownership. Results showed that higher total direct-care nursing hours per resident day, and presence of allied health staff--disproportionately present in publicly owned facilities--were associated with lower transfer rates. A number of other facility organizational characteristics--unrelated to ownership--were also associated with transfer rates.

BackgroundAs individuals age, they are more likely to experience increasing frailty and more frequent use of hospital services. First, we explored whether initiating home-based primary care in a frail homebound cohort, influenced hospital use. Second, we explored whether initiating regular home care support for personal care with usual primary care, in a second somewhat less frail cohort, influenced hospital use.MethodsThis was a before-after retrospective cohort study of two frail populations in Vancouver, Canada using administrative data to assess the influence of two different services started in two different cohorts over the same time period. The participants were 246 recipients of integrated home-based primary care and 492 recipients of home care followed between July 1st, 2008 and June 30th, 2013 before and after starting their respective services. Individuals in each group were linked to their hospital emergency department visit and discharge abstract records. The main outcome measures were mean emergency department visit and hospital admission rates per 1000 patient days for 21 months before versus the period after receipt of services, and the adjusted incidence rate ratios (IRRs) on these outcomes post receipt of service.ResultsBefore versus after starting integrated home-based primary care, emergency department visit rates per 1000 patient days (95% confidence intervals) were 4.1 (3.8, 4.4) versus 3.7 (3.3, 4.1), and hospital admissions rates were 2.3 (2.1, 2.5) versus 2.2 (1.9, 2.5). Before versus after starting home care, emergency department visit rates per 1000 patient days (95% confidence intervals) were 3.0 (2.8, 3.2) versus 4.0 (3.7, 4.3) visits and hospital admissions rates were 1.3 (1.2, 1.4) versus 1.9 (1.7, 2.1). Home-based primary care IRRs were 0.91 (0.72, 1.15) and 0.99 (0.76, 1.27) and home care IRRs were 1.34 (1.15, 1.56) and 1.46 (1.22, 1.74) for emergency department visits and hospital admissions respectively.ConclusionsAfter enrollment in integrated home-based primary care, emergency department visit and hospital admission rates stabilized. After starting home care with usual primary care, emergency department visit and hospital admission rates continued to rise.

Margaret McGregor and colleagues consider Bradford Hill’s framework for examining causation in observational research for the association between nursing home care quality and for-profit ownership.

ccupational and environmental health nurses must be able to analyze the economic benefits of measures for reducing work related injury. An example of such analysis is provided by a hospital in British Columbia, Canada where mechanical equipment to assist in patient lifting was installed to reduce musculoskeletal injuries (MSI) among health care workers. All costs and benefits attributable to this intervention were identified and measured for a I year period preceding and following the intervention. Direct savings alone produced a payback within 4 years, and the payback occurs more quickly when the effect of indirect savings or the trend to rising compensation costs is considered. From the perspective of the facility itself, benefits exceed costs by a factor of more than 6 to I, representing an internal rate of return of 17.9%. Use of this business case summary, together with other knowledge of determinants of worker well being, helped secure a commitment for wide spread implementation of similar projects.

The overall use of acute care services by nursing home (NH) residents in Canada has not been well documented. Our objectives were to identify the major causes of hospitalization among NH facility residents and to compare rates to those of community-dwelling seniors. A retrospective cohort was defined using population-level health administrative data, including all individuals aged 65 years and older living in a British Columbia NH facility between April 1996 and March 1999. Hospitalization rates of NH residents were compared to estimated rates for community-dwelling seniors, using age- and sex-adjusted standardized incidence ratios (SIRs): SIR = 2.81 (95%CI: 2.71, 2.91) for femoral fractures, 1.96 (1.88, 2.04) for pneumonia, 0.73 (0.70, 0.76) for other heart disease, and 1.01 (0.99, 1.02) for all causes. NH residents have disproportionately higher rates of hospitalization for femoral fractures and pneumonia, with NH residents accounting for approximately one quarter of all femoral fracture hospitalizations of BC seniors.

P ublic funds can be used to pay for health care services that are delivered either by for-profit or not-for profit agencies. A systematic review of patient outcomes in US hospitals by ownership status showed that not-for-profit hospitals tended to produce better results.1 Although there are no Canadian acute care hospitals in the for-profit sector, the issue of interest here is whether the same trend in outcomes applies to for-profit and not-for-profit ownership of long-term care facilities.About 60% and 30% of all publicly funded long-term care beds in Ontario and British Columbia, respectively, are in forprofit institutions.2,3 The co-existence of for-profit and notfor-profit providers in the same province creates a "natural laboratory" for examining their differences. This is particularly true because the funding paid by the province to these facilities is tied to resident care requirements and thus the same amount is paid per standardized patient whether he or she is in a for-profit or a not-for-profit facility. Despite this, there has been relatively little Canadian research that examines the experiences of residents in these 2 types of facilities. Although there is an abundance of evidence from the United States demonstrating superior performance of the not-forprofit sector in measures of quality of care, there are claims that these findings have limited generalizability in Canada because of differences in the 2 countries' health care systems. However, a few Canadian studies are now starting to provide a portrait of what public investment "buys" in for-profit and not-for-profit facilities. How is the money spent?Long-term care facilities, like hospitals, are labour-intensive; therefore, staffing costs account for a significant portion of total expenditures. Unlike many parts of the United States, Canada has no legislated minimal requirements for staffing in longterm care facilities. Instead, institutions either face requirements for minimum spending in different categories as dictated by "funding envelopes" (as in Ontario), or are free to choose how to apportion their funding (as in British Columbia).There is now increasing evidence that the for-profit and not-for-profit sectors in Canada make different spending decisions. In an Ontario study, government-operated facilities were found to provide more hours of direct patient care per resident than for-profit facilities, although the public-sector facilities also care for residents with greater health needs.2 In British Columbia, not-for-profit facilities were also found to provide more hours of direct patient care per resident than for-profit facilities, with the same funding level from government; this difference remained after adjustment for the size and level of care of the facilities.3 Adjustment for the mix of patients cared for by the 2 types of facilities is important. For example, most extended-care beds, reserved for the care of the frailest elderly patients, are in not-for-profit facilities.What are the outcomes of care?Do differences in staffing...