Does profit status affect hospitalization and mortality rates in long-term care homes?
Today, the Bruyère Research Institute (BRI) announces the findings of a new study which examines the differences in hospitalization and mortality rates of residents newly admitted to Ontario long-term care (LTC) homes (also known as nursing homes).
Published in the Journal of the American Medical Directors Association, the research project included 53,739 residents over a three-year period, from 2010 to 2012. Overall, the results indicate that for-profit facilities have significantly higher hospitalization and mortality rates than not-for-profit facilities. The study uses data housed at the Institute for Clinical Evaluative Sciences (ICES).
Six months following admission, and following adjustment for multiple factors at the individual and facility level, the mortality rate in for-profit homes was 16 per cent higher, and the hospitalization rate was 33 per cent higher in for-profit homes, than in not-for-profit homes. During this period, residents in for-profit facilities had an unadjusted hospitalization rate of 565 per 1,000 Person Years (PY) of follow-up versus 416 per 1,000 PY in not-for-profit facilities. The corresponding crude mortality rate in for-profit facilities was 252 per 1,000 PY versus 216 per 1,000 PY in not-for-profit facilities.
“Our results take advantage of a natural experiment in Ontario, where the funding level and the characteristics of residents in for-profit and not-for-profit homes are similar,” says Dr. Peter Tanuseputro, research project lead at BRI and The Ottawa Hospital. “The fact that the resident wait-list and placement system is also standardized helps maintain this similarity.”
Of Ontario’s 640 long-term care homes, 384 (or 60 per cent) are for-profit facilities. However, regardless of their profit status, all nursing homes receive standardized government funding for each patient, which is set by a formal assessment of each resident’s care needs.
“A facility’s profit status is only one of many factors that affect hospitalization and mortality rates,” states Dr. Tanuseputro. “Some for-profit facilities are in the top 20 per cent of facilities that had the lowest rates of hospitalization or mortality. Conversely, some not-for-profit facilities were in the bottom 20 per cent. Other factors such as the size and location of a facility are also important contributors.”
Previous literature suggested that differences in resident outcomes may also depend on staffing levels, ease of access to specialized medical services and additional sources of generated income such as donations.
An accompanying online calculator uses the study findings to predict the chance that a long-term care resident will die in the six months after admission:
It considers information such as a person’s socio-demographics (e.g., age, sex and marital status), a person’s health and the characteristics of the nursing home. This calculator can be used by residents, their family members and/or caregivers to inform care planning.
"Hospitalization and Mortality Rates in Long-Term Care Facilities: Does For-Profit Status Matter?" was published today in the Journal of the American Medical Directors Association.
Author block: Peter Tanuseputro, Mathieu Chalifoux, Carol Bennett, Andrea Gruneir, Susan E. Bronskill, Peter Walker, Douglas Manuel.
The Bruyère Research Institute is a bilingual not-for-profit organization which partners with Bruyère and the University of Ottawa to support researchers who contribute to relevant and practical knowledge through programs of health research and programming related to primary and community care, equity, cognition and mobility, health systems and services, and promising practices.
ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario
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