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Nurse Staffing and Deficiencies in the Largest For-Profit Nursing Home Chains and Chains Owned by Private Equity Companies

Keywords: Ownership/governance (for-profit/NFP/public/chains/systems); long-term care: home care/nursing homes; quality of care/patient safety (measurement).

Objective: To compare staffing levels and deficiencies of the 10 largest U.S. for-profit nursing home chains with five other ownership groups and chain staffing and deficiencies before and after purchase by four private equity (PE) companies.

Data Sources: Facilities for the largest for-profit chains were identified through Internet searches and company reports and matched with federal secondary data for 20032008 for each ownership group.

Study Design: Descriptive statistics and generalized estimation equation panel regression models examined staffing and deficiencies by ownership groups in the 20032008 period, controlling for facility characteristics, resident acuity, and market factors with state fixed effects.

Principal Findings: The top 10 for-profit chains had lower registered nurse and total nurse staffing hours than government facilities, controlling for other factors. The top 10 chains received 36 percent higher deficiencies and 41 percent higher serious deficiencies than government facilities. Other for-profit facilities also had lower staffing and higher deficiencies than government facilities. The chains purchased by PE companies showed little change in staffing levels, but the number of deficiencies and serious deficiencies increased in some postpurchase years compared with the prepurchase period.

Conclusions: There is a need for greater study of large for-profit chains as well as those chains purchased by PE companies.

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