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Picking a nursing home? Read the fine print on profit

Nursing homes that aren’t run for profit tend to keep their residents healthier than do private outfits, says research done in the U.S. and British Columbia and presented at a recent forum sponsored by the BC Health Coalition.

Charlene Harrington, a professor of sociology and nursing at the University of California San Francisco, shared her research on nursing homes in the U.S.

There, 67 per cent of homes are operated as for-profit private businesses. Four of the top American nursing home firms are owned by private equity companies. And the Roto-Rooter Corporation, believe it or not, is now one of the largest companies in America delivering hospice care to the dying.

In Canada, 41 per cent of long term care homes are for-profit, 35 per cent are non-profit and 24 per cent are publicly operated.

Does any of this matter? Harrington’s research shows that it does. For example, a 2001 study shows that “investor-owned facilities averaged 5.89 deficiencies per home, 46.5 per cent higher than nonprofit facilities and 43.0 per cent higher than public facilities.”

Harrington and her fellow researchers concluded that “investor-owned nursing homes provide worse care and less nursing care than do not-for-profit or public homes.”

Canadian research reveals similar connections between for-profit ownership and inferior care for seniors.

Dr. Margaret McGregor combines medical practice at Vancouver’s Mid-Main Community Health clinic with research positions at UBC and Vancouver Coastal Research Institute. McGregor told the forum that in B.C. only 30 per cent of long term care homes are operated on a for-profit basis, and both for-profit, non-profit and public homes all depend on government funding, so the province presents an ideal laboratory experiment into which form of ownership delivers, on average, the best care.

McGregor’s research found that, in B.C., similar amounts of public money invested in caring for similar types of residents pay for significantly different numbers of care providers and levels of care.

For example, residents in non-profit homes in B.C. receive a mean of 20 minutes a day more personal care than residents in for-profit care homes. Those 20 minutes a day could add several assisted toileting events (eight minutes each) and prevent a resident from lying in one’s own waste.

In a 2006 study, McGregor and other researchers looked at how often residents at long-term care homes were hospitalized for anemia, pneumonia, dehydration, falls, urinary tract infection and decubitus ulcers and gangrene, all viewed as possible indicators of poor care.

For five of the six categories, for-profit facilities sent more patients to hospital than non-profits.

In the sixth category, ulcers and gangrene, the level of hospitalization was equal between the two ownership types.

Tom Sandborn is a Tyee contributing editor and a regular on The Hook. He welcomes your feedback and story tips at tos@infinet.net.

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