Do For-Profit and Not-for-Profit Nursing Homes Behave Differently?

Aaronson, William E.; Zinn, Jacqueline S.; Rosko, Michael D.

doi:10.1093/geront/34.6.775

Cited by 147 publications

(101 citation statements)

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“…Although the role of activity aides has not been studied extensively, Reid and colleagues found that higher ratios of activity aides to residents had beneficial effects on residents' cognitive function and social and language skills. 22 The finding that not-for-profit ownership was associated with a higher mean number of hours per resident-day is consistent with US findings 10,23 and suggests that in both countries the financial imperatives of for-profit ownership in nursing home care operate in a similar manner. One of these imperatives may be the higher property costs associated with private investment.…”

Section: Discussionsupporting

confidence: 58%

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Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter?

McGregor

Cohen²,

McGrail³

et al. 2005

Canadian Medical Association Journal

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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...

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Section: Discussionsupporting

confidence: 58%

“…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.…”

mentioning

confidence: 99%

Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter?

McGregor

Cohen²,

McGrail³

et al. 2005

Canadian Medical Association Journal

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“…The results are roughly consistent with the theory (Hawes and Phillips, 1986;Weisbrod, 1988Weisbrod, , 1994Aaronson et al, 1994). One study of nursing homes recorded more complaints against proprietary than against non-profit homes (Weisbrod and Schlesinger, 1986).…”

Section: Empirical Evidencesupporting

confidence: 79%

Altruism, ideological entrepreneurs and the non-profit firm

Rose‐Ackerman

1997

Voluntas

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Ideology and altruism are central to understanding the non-profit charitable sector. This paper addresses three questions. Why do people make charitable gifts? Why do they usually give to non-profit organisations? When can non-profits run by committed ideologues compete with profitoriented entrepreneurs in the provision of services? The altruistic motives of individuals and the ideological commitments of entrepreneurs come together to support charitable organisations. The non-profit form provides a weak guarantee that gifts are not being syphoned off as profits. Furthermore, independent non-profits can often better reflect donors' desires than public agencies constrained by majoritarian claims, and ideological entrepreneurs can use the non-profit form to reify their beliefs without being accountable to profit-seeking investors. A non-profit organisation can only survive, however, if it can attract money and customers. Sometimes its ideological character will facilitate both tasks. Non-ideological customers may, nevertheless, patronise an ideological non-profit if the entrepreneur's commitment helps to guarantee high quality.Ideology and altruism are central to an understanding of the non-profit charitable sector. Even though private giving represents only about one quarter of the sector's resources, donations are an important financial anchor for many non-profits, and most charitable gifts are made to non-profit organisations. I In this context, there are three questions of interest. Why do people make charitable gifts? Why do they usually give to non-profits as opposed to governments or for-profit firms? And when can non-profits run by committed ideologues successfully compete with profit-oriented entrepreneurs in the provision of services?

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“…An early study of nonhospital ser vice indus tries indicated less effi ciency in nonprofits than in for-prof its but they did not take into account the pos si bil ity that nonprofits were sup ply ing dif fer ent kinds or quali ties of ser vices (Clark son & Mar tin, 1980). Recent stud ies of nurs ing homes gen er ally cor rob o rate the o ret i cal pre dic tions of higher qual ity in the non profit sec tor (Aaronson, Zinn, & Rosko, 1994;Weisbrod, 1997) and that the higher qual ity ser vices of nonprofits cost more to pro duce (Arling, Nordquist, & Capitman, 1987;Marmor, Schlesinger, & Smithey, 1986), sug gest ing mar ket seg men ta tion with for-prof its and nonprofits serv ing dif fer ent cli en tele. Weisbrod's (1988Weisbrod's ( , 1997) stud ies of nurs ing homes, psy chi at ric care facil i ties, and facil i ties for the men tally hand i capped were the first to com pare per formance of subsectors within the non profit sec tor and to look for evi dence that for-profit estab lish ments shave qual ity on aspects of care that fam i lies can not eas ily mon i tor.…”

Section: Eco Nomic Per For Mance In Mixed In Dus Triesmentioning

confidence: 99%

Child Care Center Quality Differences: The Role of Profit Status, Client Preferences, and Trust

Morris¹,

Helburn

2000

Nonprofit and Voluntary Sector Quarterly

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This study uses the Cost, Qual ity, and Child Out comes in Child Care Cen ters data set to inves ti gate the view that in a mixed indus try pro vid ing com plex ser vices to poorly informed cus tom ers, for-profit pro duc ers pro vide lower qual ity than non profit pro duc ersCen ter child care pro vi sion in the United States occurs in a mixed indus try with roughly 60% non profit agen cies (includ ing a few that are pub licly operated) and 40% for-profit busi nesses. This study con trib utes to the body of research on sec toral dif fer ences in qual ity per for mance in the child careNote: This re search has been funded by a grant from the As pen In sti tute and is a fol low-up on Cost, Qual ity, and Child Out comes in Child Care Cen ters. That re search was con ducted by a team of schol ars in clud ing the cur rent au thors and Mar ga ret Burchinal, Donna Bryant, Rich ard Clifford, Debby Cryer, Mary Culkin, Carollee Howes, Sharon Lynn Kagan, H. Naci Mocan, Leslie Phillipsen, El len S. Peisner-Feinberg, and Jean Rustici and funded by the Car ne gie Cor po ra tion, Wil liam T. Grant Foun da tion, The JFM Foun da tion, The Da vid and Lucile Packard Foun da tion, the Pew Char i ta ble Trusts, the USWEST Foun da tion, and an other anon y mous foun da tion. We wish to thank Dan iel I. Rees and Laura Argys for their sug ges tions at var i ous stages of the re search and Barbara Bergmann, Bur ton Weisbrod, and the anon y mous re view ers of Non profit and Vol untary Sec tor Quar terly for con struc tive crit i cisms of ear lier drafts of this ar ti cle. An ear lier ver sion of this ar ti cle was pre sented at the ARNOVA con fer ence, Se at tle, WA, No vem ber 1998.

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Do For-Profit and Not-for-Profit Nursing Homes Behave Differently?

Cited by 147 publications

References 0 publications

Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter?

Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter?

Altruism, ideological entrepreneurs and the non-profit firm

Child Care Center Quality Differences: The Role of Profit Status, Client Preferences, and Trust

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