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The Shift to For-Profit Nursing Homes and Spike in Neglect Complaints

It is unfortunately not a new trend.

The 1986 report For-Profit Enterprise in Health Care found that for-profit nursing home facilities devoted fewer resources to direct patient care, and that led to lower quality care overall.

At the time, in most places, the split between for-profit and not-for-profit homes was around 50-50. The same can not be said for 2016.

As demand outpaces the supply of available spots, nursing homes are increasingly becoming for-profit enterprises. According to the CDC, 69.8% of nursing homes nationwide are for-profit as of 2014. The number is slightly lower in New York State – just under 60% – but the trajectory is the same across the country.

Nursing homes are largely for-profit these days. And that’s bad news for our elderly citizens.

The Government Accountability Office found that Special Focus Facilities (those identified as poorest performing nationwide) were far more likely to be for-profit, part of a chain, and have 24% fewer RNs/resident/day staff.

A recent study published in The Journal of the American Medical Directors Association discovered death and hospitalization rates were “significantly higher” – 16% and 33% respectively – in Ontario for-profit facilities.

An analysis of ten large for-profit nursing home chains between 2003-2008 revealed they had the lowest staff levels, the highest number of deficiencies as identified by public regulatory agencies, and the highest instances of deficiencies causing harm or jeopardy to their residents.

Finally, a review of 82 independent studies found not-for-profit homes had higher quality care, higher staffing numbers, and fewer cases of pressure sores. The authors estimate that there’d be 7000 fewer residents with pressure sores and 500,000 additional hours of nursing care each day if all care facilities were not-for-profit.

When profit and the bottom line become the focus, the quality of care and available resources goes down. The number of staff looking after residents is smaller. The rate of death, injury, and complaint goes up. Dollars and cents above all else.
The nursing home industry overcharges Medicare by roughly $1.5 billion per year according to some sources. 30% of for-profit invoices are deemed inappropriate by federal health inspectors, compared to only 12% for not-for-profit centers. It’s all about the money.

The situation in New York is dire. With over 100,000 residents in nursing care – the largest group in the country – the facilities in the state are consistently ranked at or near the bottom. Families for Better Care – a non-profit citizen advocacy group – releases an annual report card on the nation’s nursing homes. New York has received an “F” the past three years, ranking 45th in America. In 2015, a staggering 95% of care facilities in the state received at least one deficiency citation, up 3% over the previous year.

A Kaiser Family Foundation report revealed that 42% of for-profit homes in New York received only 1 or 2 stars on Medicare’s national rating system, nearly twice as much as their not-for-profit counterparts.

Fewer staff members. Lower quality care. Higher instances of injury. It’s a recipe for disaster.
In 2006, for-profit companies owned about half of all nursing homes in New York. That number is nearly 60% now, and still rising.

According to the New York Attorney General’s Office, nursing home complaints rose from 1392 to 1644 between 2013 and 2015. That’s an increase of roughly 18% over less than two years.

Not-for-profits consistently have higher staff levels – and are therefore better suited to look after their residents – and fewer health deficiencies than for-profits. That much is certain.

While we can’t do much about the not-for-profit to for-profit slide, we can insist that complaints are investigated. That deficiency citations are followed-up. That inspections happen frequently and that recommendations are implemented. That companies are held responsible for injury, abuse, and neglect.

Lives over cash. Care over profit. Safety, comfort, and respect over dollars, cents, and revenue. Make your voice heard. Our elderly citizens deserve better.