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

Abstract

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...

Planning the Restructuring of Long-Term Care: The Demand, Need and Provision of Institutional Long-Term Care Beds in Newfoundland and Labrador

“…In Ontario, 52% of publicly funded nursing homes are for-profit, whereas in Manitoba the proportion is 15%. [17] The not-for profit sector constitutes the majority of nursing home care across the country. [17] Traditionally, long-term care facilities' funding was based on historical budgets, where the more money spent the more institutional funding was provided.…”

“…[17] The not-for profit sector constitutes the majority of nursing home care across the country. [17] Traditionally, long-term care facilities' funding was based on historical budgets, where the more money spent the more institutional funding was provided. [1] Between 1980 and 1995, residential and community long-term care expenditures in Ontario increased more than 400% (26 million to 2.14 billion), despite the fact that the institutional sector's growth was generally restrained in the 1990's.…”

“…As of 2001, long-term care facilities in BC had no set regulations on how the provincial funding should be distributed between staffing, administrations or property costs. [17] The Continuing Care Division is BC's comprehensive and integrated service delivery system for the elderly and disabled. [17] In 1997, British Columbia was continuing to lead the way in meeting the needs of its elderly population for long-term care.…”

“…[17] The Continuing Care Division is BC's comprehensive and integrated service delivery system for the elderly and disabled. [17] In 1997, British Columbia was continuing to lead the way in meeting the needs of its elderly population for long-term care. A paper by Brody et al concluded that BC's long-term care system appeared to be essentially complaint-free, but users did experience dissatisfaction.…”

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

“…Not-for-profit care is delivered by religious, cultural, other community-based societies, regional health authorities, or by publicly owned acute care hospitals (McGregor et al, 2005).…”