Observational Evidence of For-Profit Delivery and Inferior Nursing Home Care: When Is There Enough Evidence for Policy Change?

Abstract

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.

Nordic eldercare – Weak universalism becoming weaker?

“…Key variables are whether or not a) private providers operate for-profit, b) the care system is organised by market mechanisms, such as competition for contracts and consumer choice models, and c) market rules enable private providers to offer 'topping up' services. If for-profit providers compete for contracts or customers and are allowed to offer topping up services, the likely result is de-universalising in the form of a wider spread of service quality: lower in many private services, as the profit motive diverts resources from care provision (Ronald et al, 2016), and higher in others, as members of highlyresourced social groups are better able to navigate the market to find the best services, and to use their own resources to top up the publicly-subsidised offering (Moberg 2016). By contrast, deuniversalisation is less likely if private provision takes the form of non-profit organisations offering services within communitarian, rather than competitive institutional arrangements, without the opportunity to top up.…”

Shaping attitudes: The association between prior contact with residential aged care and resistance to enter residential aged care

“…RAC is strongly associated with negative perceptions and discrimination within the general public, (Ronald et al, ). These negative perceptions are heavily influenced by ageist attitudes, fears towards ageing and the media coverage of the RAC sector.…”

“…For example, RAC staff are associated with lower remuneration, lower job satisfaction and high job strain (Moyle, Hsu, Lieff, & Vernooij‐Dassen, ; Moyle, Murfield, Griffiths, & Venturato, ). The media's overly negative focus on the industry exacerbates these negative perceptions (Ronald, McGregor, Harrington, Pollock, & Lexchin, ). Consequently, the RAC sector is neither aspirational for potential employees nor encouraging for staff retainment.…”

Staffing standards and care outcomes in for-profit and not-for-profit religious-based nursing homes

“…The NFP NHs are nongovernmentally owned by religious, community groups, or agencies and operated as nonprofit organizations (Ronald, McGregor, Harrington, Pollock, & Lexchin, 2016). They are precluded from an assignment of property rights; they do not have defined shareholders, are not subject to the pressure of distributing profits (Grabowski et al, 2013;Harrington, Olney, et al, 2012;Hirth et al, 2013;Weech-Maldonado et al, 2012), and are expected to use the profit derived from operation for the benefit of the clients (Ronald et al, 2016). This category of NHs, especially the religious-based NHs, exist to provide value based services (Paul III et al, 2016).…”

“…These facilities are precluded from an assignment of property rights; they do not have defined shareholders, and are not subject to the pressure of distributing profits (Grabowski et al, 2013;Hirth et al, 2013;Weech-Maldonado et al, 2012). On the contrary, the NFP facilities are expected to use the profit derived from operation for the benefit of the clients (Ronald et al, 2016). Effective performances of the NFPRB NHs are measured by the outcomes in how well they provide services; take care and meet the immediate needs of customers (Jacobs & Polito, 2012).…”