COMPARING SERVICE AND QUALITY AMONG CHAIN AND INDEPENDENT U.S. NURSING HOMES DURING THE 1990s
نویسندگان
چکیده
Purpose: This article evaluates the impact of chain ownership of nursing homes by examining whether facilities demonstrate variation in services, staffing and health outcomes across three structural dimensions—chain ownership, chain and facility size and proprietary status. Design and Methods: We link files of facility inspection reports from 1991 through 1997, excluding government facilities. Chain ownership was identified from reported names of corporate owners. We examine differences in means for measures of case mix, service availability, and health outcomes by ownership and size categories. Results: Most nursing home chains own fewer than ten facilities. Chain-owned facilities, in general, provide lower staffing but a higher proportion of beds for rehabilitative care and Alzheimers’ patients. There are negligible differences in case mix across chain and non-chain facilities. Overall, quality is poorer among for-profit facilities but does not vary with chain ownership. Implications: Results indicate that chain and for-profit ownership have distinct and often different effects on services, staffing and health outcomes. Chain ownership may mediate the negative effects of the profit motive by providing administrative structures for facilitating quality care. Further multivariate research is needed to distinguish the effects of chain and for-profit ownership.
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