For-profit versus not-for-profit delivery of long-term care

Abstract

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...

The role of the nurse practitioner in promoting a reduction in the causes and outcomes of problematic polypharmacy among nursing home residents in British Columbia

“…Both for-profit and not-for-profit facilities are allotted the same amount of public funds per resident for care requirements (McGrail et al, 2007). However, there is no legislated minimal requirements for staffing in nursing homes (McGrail et al, 2007), thus how funds are allocated can be dependent on the organizational model.…”

“…However, there is no legislated minimal requirements for staffing in nursing homes (McGrail et al, 2007), thus how funds are allocated can be dependent on the organizational model. For example, in BC not-for-profit facilities provide more hours of direct resident care by health care professionals than for-profit facilities (McGregor et al, 2005).…”

“…For example, in BC not-for-profit facilities provide more hours of direct resident care by health care professionals than for-profit facilities (McGregor et al, 2005). Less resident care hours within for-profit facilities may reflect a situation of understaffing in these facilities, in order to divert some funding to profit (McGrail et al, 2007).…”

“…Lower hospital transfer rates may be facilitated in not-for-profit facilities by providing more time on direct resident care (McGregor et al, 2005), and connections and collaboration with acute care hospitals and health authorities (McGrail et al, 2007). This allows not-for-profit facilities to benefit from these affiliations through greater access to specialized professionals, who are able to develop and implement care policies (McGrail et al, 2007 warranted. This provides clarity in how NPs may address problematic polypharmacy partly through ensuring interventions best implemented by other health care professionals are sustained.…”

“…However, within some nursing homes, including facilities in BC, staff face barriers that impede the optimal integration of interventions. For example, funding (McGrail, McGregor, Cohen, Tate, & Ronald, 2007), co-location (Divisions of Family Practice [DOFP], 2016), and time constraints (Murphy, 2006;Singh, 2016) are some factors that pose a barrier for health care professionals to prioritize their focus on implementing interventions to reduce the causes and outcomes of problematic polypharmacy.…”