Journal Article

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

Harrington, Charlene, Pollock, Allyson, Lexchin, Joel, Ronald, Lisa A., McGregor, Margaret J.

2016

Overview

Abbreviations: CI, confidence interval; HMOs, Health Maintenance Organizations; MDS, Minimum Data Set; RCTs, randomized controlled trials Provenance: Not commissioned; externally peer-reviewed Summary Points * Nursing home residents are a highly vulnerable population, and nursing home care quality has been a persistent focus of public concern. * There is considerable evidence from observational studies that public funding of care delivered in for-profit facilities is inferior to care delivered in public or nonprofit facilities. * The past decade has seen many industrialized countries increasing governmental payment for care of frail seniors in for-profit nursing homes, leading to questions about whether this leads to inferior care. * Many of Bradford Hill's guidelines for causation can be found in published studies supporting a causal link between for-profit ownership and inferior care. * The precautionary principle should be applied when developing policy for this frail and vulnerable population. Introduction Nursing homes, also called residential long-term care facilities or aged care homes, are regulated institutions providing around-the-clock medical and social care to (mainly) older people who are unable to live independently due to physical and/or mental disability. Because of the vulnerability of this population and frequent media reports of scandals across many industrialized countries [1], nursing home care quality has been a persistent focus of public concern.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Aged / Analysis / Assisted living facilities / Commerce - economics / Commerce - legislation & jurisprudence / Commerce - standards / Commerce - trends / Confidence intervals / Contract Services - economics / Contract Services - legislation & jurisprudence / Contract Services - standards / Contract Services - trends / Cost Savings / Cost-Benefit Analysis / Delivery of Health Care - economics / Delivery of Health Care - legislation & jurisprudence / Delivery of Health Care - standards / Delivery of Health Care - trends / Evidence-Based Medicine - legislation & jurisprudence / Frail Elderly / Frailty / Funding / Health Care Costs / Health Expenditures / Health Policy - economics / Health Policy - legislation & jurisprudence / Health Policy - trends / Health Services Research / Home ownership / Homes for the Aged - economics / Homes for the Aged - legislation & jurisprudence / Homes for the Aged - standards / Homes for the Aged - trends / Humans / Medical care / Medical care quality / Medicine and Health Sciences / Nonprofit organizations / Nursing homes / Nursing Homes - economics / Nursing Homes - legislation & jurisprudence / Nursing Homes - standards / Nursing Homes - trends / Observational Studies as Topic / Older people / Ownership - economics / Ownership - legislation & jurisprudence / Ownership - standards / Ownership - trends / People and Places / Policy Forum / Policy Making / Population / Private equity / Quality / Quality Improvement - legislation & jurisprudence / Quality Indicators, Health Care - economics / Quality Indicators, Health Care - legislation & jurisprudence / Quality Indicators, Health Care - standards / Quality Indicators, Health Care - trends / Quality management / Research and Analysis Methods / Savings bonds / Social Sciences / Studies / Taxonomy / Time Factors / Trends / Vulnerable Populations - legislation & jurisprudence