Table 5.
Characteristics of studies comparing for-profit and not-for-profit nursing home quality of care (public and private NFP homes)
| Study | Place; year; data source*; No of residents or nursing homes | Factors controlled or adjusted for | |
|---|---|---|---|
| Appropriate: age, severity of illness, severity of dementia, and payment status adjustments | Inappropriate: quality measures used in other studies; measures of intensity of care | ||
| Winn 1974w35 | Washington state; 1971; mailed questionnaire to administrators; 24 FP, 24 NFP | Unadjusted analysis | Unadjusted analysis |
| Riporttella-Muller and Slesinger 1982w36 | Wisconsin; July 1977-June 1978; Wisconsin Department of Health and Wisconsin Nursing Homes Ombudsman Program; 462 homes | Adjusted analysis but none of 4 selected appropriate factors included | None |
| Nyman 1984w37 | Wisconsin; 1978-9; 1979 Wisconsin Nursing Home Survey, Quality Assurance Project Pre-test, and Cost-Quality Study dataset; 88 cases of nursing home violations (No of nursing homes not indicated) | Payment source; severity of illness (need for intermediate, personal, or residential care by payment source) | None |
| Brunetti et al 1990w38 | North Carolina; 1987; surveys to nursing home administrators; 236 nursing homes (164 FP, 40 NFP) | Certification (Medicare only, Medicaid only, or Medicare and Medicaid) | None |
| Munroe 1990w39 | California; 3 December 1985 to 30 December 1986; Office of Statewide Health Planning and Development of California; 455 homes | Illness severity (ADLs/IADLs); payment status | Proportions of residents with catheters and decubiti; ratio of RN to LVN hours per resident day |
| Cherry 1991w40 | Missouri; 1984; Missouri State Board of Health; 134 homes | Payment status | RN, LPN, aide hours per resident |
| Kanda and Mezey 1991w41 | Pennsylvania; 1980, 1982, 1985, 1987; Long Term Care Facilities Survey conducted by State Health Data Center, Pennsylvania Department of Health; 407 homes for 1980, 395 for 1982, 395 for 1985, 461 for 1987 | Age of residents (in RN staffing comparison, when each year was analysed separately) | None |
| Cherry 1993w42 | Missouri; 1984; Missouri Division of Aging Routine Inspections and Missouri State Board of Health; 210 nursing homes | Adjusted analysis but none of 4 selected appropriate factors included | Nurse ratio |
| Zinn et al 1993w43 | Pennsylvania; 1987; MMACS, Pennsylvania Long Term Care Facility Questionnaire; 438 homes | Payment status | RNs per resident |
| Zinn 1993w44 | 46 continental US states; 1987; AHCA and MMACS; approximately 14 000 homes | % private pay; % confused; % Medicare; functional severity index | RN, LPN, aide staffing; rate of catheter use, restraint use, and tube feeding |
| Graber and Sloane 1995w45 | North Carolina; 1991; OSCAR, North Carolina Division of Medical Assistance, Office of State Health Planning; 195 homes | Illness severity (% intubated patients, facility disability level, % with incontinent residents) | RN ratio; LVN/nursing assistant ratio; % of residents on psychotropic drugs |
| Christensen and Beaver 1996w46 | Oregon; 1991-4; Oregon Board of Examiners of Nursing Home Administrators and State surveyors reports; 147 nursing homes (37 NFP or government and 110 FP) | Unadjusted analysis | Unadjusted analysis |
| Mukamel 1997w47 | New York (excluding New York City); 1986-90; New York State Department of Health; approximately 550 homes, 42.3% of residents in proprietary homes, 39.9% of residents in voluntary NFP homes, 17.8% in public homes | Unadjusted analysis | Unadjusted analysis |
| Anderson et al 1998w48 | Texas; 1990; Texas Medicare Nursing Facility Cost Reports and Client Assessment, Review, and Evaluation form; 494 nursing homes | % of private pay | RN, LPN, aide staffing |
| Bliesmer et al 1998w49 | Minnesota; 1988-91; Minnesota Department of Human Services Long-Term Care Division facility profiles and assessments of residents by RNs; 4103 residents in 1988, 4676 residents in 1989, and 4672 residents in 1990 | Age | Compliance with regulations |
| Castle and Fogel 1998w50 | United States; 1995; OSCAR, ARF; 15 074 homes | Illness severity (ADLs, incontinent bladder/bowel); payment status | Psychotropic drug use; staffing (high/medium/low RNs, LPNs, nursing assistants per resident) |
| Anderson and Lawhorne 1999w51 | Advance care directive prevalence; feeding tube prevalence; drug errors noted on survey; pressure ulcer prevalence; restraint use prevalence; staffing—direct care hours per resident per day; urinary catheterisation prevalence | All significant (P<0.05) comparisons favoured NFP: non-significantly favoured NFP for drug errors, non-significantly favoured FP for restraint use prevalence; favoured NFP for all other comparisons | None |
| Bravo et al 1999w52 | Eastern townships of Quebec (Canada); 1996; resident interviews; 301 residents from 88 nursing homes | Age; cognitive functioning (MMMS score); functional autonomy (SMAF score) | Staff to resident ratio |
| Castle 1999w53 | CA, CT, IA, MD, MA, OH OR, TN, TX, and VA: 1990 and 1993, Resident Assessment Instrument and OSCAR; 268 facilities (90% in each cohort FP) | Age; ADLs; severity of illness; severity of dementia; payment status | Staffing levels |
| Ballou 2000w54 | Wisconsin; 1987-95; Wisconsin Centre for Health Statistics and Wisconsin Bureau of Quality Assurance | Unadjusted analysis | Unadjusted analysis |
| Castle 2000w55 | United States; 1997; OSCAR; 17 024 homes | Dementia; ADLs | Staffing (RNs, LPNs, nurse aides, specialists per resident and nurse aide training); pressure ulcer incidence; urinary catheterisation; use of psychoactive drugs |
| Castle 2000w56 | United States; 1992 and 1997; OSCAR; 15 455 homes in 1992; 16 533 homes in 1997 | ADLs; payment status | Staffing (RNs, LPNs, nurse aides, rehabilitation assistants per 100 beds); antipsychotic drug use; residents with psychiatric problems |
| Castle 2001w57 | United States; 1999; OSCAR; 420 nursing facilities and OSCAR 1999 (~16 000 homes) | ADLs; dementia; payment status | Catheterisation; psychoactive drug use; physical restraint use; pressure ulcers; psychological disorders |
| Castle 2001w58 | United States; 1997; OSCAR; 16 871 homes | Age; ADLs | None |
| Castle 2001w59 | United States; 1992-7 and 1999; OSCAR (1992-7); 13 162 nursing homes | ADLs; private pay occupancy | Nurse staffing |
| Dubois et al 2001w60 | Eastern townships of Quebec (Canada); 1996; resident interviews; 88 nursing homes | Age | Staff to resident ratio; percentages of professionals among staff |
| Keith 2001w61 | A “Midwestern state”; 2 year period (year not specified); primary mail questionnaire and Area Agencies on Aging; questionnaire data from 633 volunteers and 1886 records | Adjusted analysis but none of 4 selected appropriate factors included | None |
| O’Neill et al 2001w62 | United States; 1999; OSCAR; 1098 homes | ADLs; dementia | Staffing (administration, medical director, RNs and LPNs, nurse aides per 10 residents) |
| Castle 2002w63 | United States; 1996-9; OSCAR; 14 042 homes | ADLs; payment status | Psychiatric problems |
| Lee et al 2002w64 | Taiwan; 1999; Quality Assessment Index; 28 homes (12 chain/FP, 12 independent/FP, and 4 NFP) | Adjusted analysis but none of 4 selected appropriate factors included | Ratio of nurses to average number of daily residents |
| Allen et al 2003w65 | Connecticut; 1998-2000; Connecticut Ombudsman Reporting System; 3443 complaints combined with related data from state’s 261 nursing homes | Medicaid percentage | Nurse/resident ratio |
| Allen et al 2003w66 | Connecticut; 1998-2000; Long-Term Care Ombudsman Program complaint data; 3360 complaints from 261 nursing homes | Medicaid occupancy | Staffing (full time employee ratio of RNs, LPNs, and certified nursing assistants to total number of beds/facility) |
| Anderson et al 2003w67 | Texas; date of survey administration not provided (secondary data from 1995); survey data from nursing home staff and 1995 Texas MDS; 164 nursing homes | Adjusted analysis but none of 4 selected appropriate factors included | None |
| Castle and Banaszak-Holl 2003w68 | United States; 1999; OSCAR; 15 834 homes | Dementia; severity of illness (ADLs) | None |
| Harrington and Swan 2003w69 | California; 1999; state cost reports; 1155 homes | Payment status | None |
| Weech-Maldonado et al 2003w70 | NY, KS, VT, ME, and SD; 1996; Health Care Financing Administration Investment Analyst Nursing Home Database (MDS+, OSCAR) | Adjusted analysis but none of 4 selected appropriate factors included | None |
| Baumgarten et al 2004w71 | Maryland; 1992-5; interviews with significant others or MDS+; 59 homes (1938 residents) | Unadjusted analysis | Unadjusted analysis |
| Lau et al 2004w72 | United States; 1996; MEPS NHC, 3372 residents | Age; Medicaid coverage; mental status; ADL limitations | RN to non-RN ratio; RN to resident ratio; influenza vaccination percentage |
| Castle and Engberg 2005w73 | MO, TX, CT, and NJ; 2003; primary data on staff turnover from mailed survey, OSCAR for remaining information; 526 homes | Illness severity (ADLs, incontinent bladder/bowel); dementia | Staffing (full time equivalent RNs, LPNs, nursing assistants/100 beds) |
| Chesteen et al 2005w74 | Utah; 1999; survey of certified nursing assistants, Utah Medicare/Medicaid certification program, and operational data reported to the state of Utah; 890 certified nursing assistants at 42 nursing homes | % Medicaid | None |
| Gruber-Baldini et al 2005w75 | 4 US states; year of data acquisition unclear; survey of resident care supervisors; 347 residents with dementia in 10 homes and 35 residential care/assisted living facilities | Cognitive status | % of supervisory staff trained; % of direct care providers trained |
| Intrator et al 2005w76 | United States (minus Alaska, District of Columbia, Hawaii, and Puerto Rico); 1993 to 2002; OSCAR and recent survey done by authors; 137 190 surveys from 17 635 distinct nursing facilities | Residents not paid for by Medicare or Medicaid (%), Medicare residents (%) | Total nurse hours per patient day>4.55 |
| McGregor et al 2005w77 | British Columbia; 2001; British Columbia Labour Relations Board; 167 homes | Severity of illness (levels of care) | None |
| Starkey et al 2005w78 | NY, ME, VT, and SD; 1996; MDS+, OSCAR; 1121 homes | Payment status | None |
| Stevenson 2005w79 | Massachusetts; 1998-2002; nursing home complaints received by Massachusetts DPH, OSCAR, and MDS QI; 539 nursing homes | ADLs | Survey deficiencies; staffing (nurse, aide); indwelling catheter; pressure sores |
| White 2005w80 | United States; 1997, 2001; OSCAR; ~10 000 homes in each year (unclear from article) | Payment status | None |
| Williams et al 2005w81 | 4 US states; year of data acquisition unclear; primary survey of resident care supervisors; 331 residents with dementia in 10 homes and 35 residential care/assisted living facilities | Cognitive status | Staffing |
| McGregor et al 2006w82 | British Columbia; 1 April-1 August 1999; British Columbia Linked Health Database; 43 065 residents | None for crude analysis | None for crude analysis |
ADLs=activities of daily living; DON=director of nursing; FP=for profit; IADLs=instrumental activities of daily living; LPN=licensed practical nurse; LVN= licensed vocational nurse; MMMS=modified mini-mental state examination; NFP=not for profit; RN=registered nurse; SMAF=functional autonomy measurement system.
*AHCA=American Health Care Association; ARF=Area Resource File; DPH=Department of Public Health; HCFA=Health Care Financing Administration; SAGE=Systematic Assessment of Geriatric Drug Use via Epidemiology; see table 3 for others.