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Hospitalization and mortality rates in long-term care facilities: does for-profit status matter?

Tanuseputro P, Chalifoux M, Bennett C, Gruneir A, Bronskill SE, Walker P, Manuel D. J Am Med Dir Assoc. 2015; 16(10):874-83. Epub 2015 Sep 30.


Objectives — To establish if proprietary status (ie, for-profit or not-for-profit) is associated with mortality and hospitalizations among publicly funded long-term care (nursing) homes.

Methods — We conducted a retrospective cohort study of new admissions in 640 publicly funded long-term care facilities in Ontario, Canada (384 for-profit, 256 not-for-profit). A population-based cohort of 53,739 incident admissions into long-term care facilities between January 1, 2010, and March 1, 2012, was observed. We measured adjusted rates of hospital admissions and mortality, per 1000 person-years (PY) of follow-up, among for-profit and not-for-profit facilities at 3, 6, and 12 months postadmission. Rates were measured postadmission and until discharge or death, whichever came first.

Results — One year after admission and before discharge, 11.7% of residents died and 25.7% had at least one hospitalization. After 12 months of follow-up, residents in for-profit facilities had a hospitalization rate of 462 per 1000 PY versus 358 per 1000 PY in not-for-profit facilities. During this period, the crude mortality rate in for-profit facilities was 208 per 1000 PY versus 185 per 1000 PY in not-for-profit facilities. At 3, 6, and 1 year after admission, for-profit facilities had an adjusted hazard ratio of 1.36 (95% confidence interval [CI] 1.28 – 1.43), 1.33 (95% CI 1.27 – 1.39), and 1.25 (95% CI 1.21 – 1.30) for hospitalizations and hazards of 1.20 (95% CI 1.11 – 1.29), 1.16 (95% CI: 1.09 – 1.24), and 1.10 (95% CI: 1.05 – 1.16) for mortality, respectively.

Conclusions — Publicly funded for-profit facilities have significantly higher rates of both mortality and hospital admissions.

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Keywords: Long-term care Quality indicators Hospitalization

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