Marketization in Long-Term Care: A Cross-Country Comparison of Large For-Profit Nursing Home Chains

Abstract

This article presents cross-country comparisons of trends in for-profit nursing home chains in Canada, Norway, Sweden, United Kingdom, and the United States. Using public and private industry reports, the study describes ownership, corporate strategies, costs, and quality of the 5 largest for-profit chains in each country. The findings show that large for-profit nursing home chains are increasingly owned by private equity investors, have had many ownership changes over time, and have complex organizational structures. Large for-profit nursing home chains increasingly dominate the market and their strategies include the separation of property from operations, diversification, the expansion to many locations, and the use of tax havens. Generally, the chains have large revenues with high profit margins with some documented quality problems. The lack of adequate public information about the ownership, costs, and quality of services provided by nursing home chains is problematic in all the countries. The marketization of nursing home care poses new challenges to governments in collecting and reporting information to control costs as well as to ensure quality and public accountability.

Physical restraint: perceptions of nurse managers, registered nurses and healthcare assistants

“…Poor staffing levels, especially by registered nurses, were reported to be an issue in for‐profit chains of nursing homes in the United States (Harrington et al. ). There remains ambiguity on regulation of skill mix and minimum staffing requirements in nursing home/long‐term facilities (Harrington et al.…”

For-Profit Nursing Homes in the Netherlands: What Factors Explain Their Rise?

“…In countries such as Sweden, Norway, Canada, the United Kingdom, and the United States, private equity firms are active within the nursing home sector. 6,53 Our data show that Dutch nursing home chains are also partly owned by these firms. The consequences are unclear because the international evidence on the quality performance of private equity firms is inconsistent: Studies present both indications of lower quality in private equity homes 51,54 and no harm to quality of care.…”

U.S. Nursing Home Violations of International and Domestic Human Rights Standards

“…17 For-profit owners often cut nurse staffing, especially RN staffing, and reduce wages, benefits, and pensions to maximize profits, compared to nonprofit and government facilities, which provide higher staffing and quality care. [66][67][68] For-profit nursing homes reported an average of 16% fewer staff than nonprofits after accounting for differences in resident needs in 2017. Nonprofits had 1 RN for every 28 residents, and for-profit nursing homes had 1 for every 43.…”