Secondary Logo

Institutional members access full text with Ovid®

Financial performance, employee well-being, and client well-being in for-profit and not-for-profit nursing homes: A systematic review

Bos, Aline; Boselie, Paul; Trappenburg, Margo

doi: 10.1097/HMR.0000000000000121

Background: Expanding the opportunities for for-profit nursing home care is a central theme in the debate on the sustainable organization of the growing nursing home sector in Western countries.

Purposes: We conducted a systematic review of the literature over the last 10 years in order to determine the broad impact of nursing home ownership in the United States. Our review has two main goals: (a) to find out which topics have been studied with regard to financial performance, employee well-being, and client well-being in relation to nursing home ownership and (b) to assess the conclusions related to these topics. The review results in two propositions on the interactions between financial performance, employee well-being, and client well-being as they relate to nursing home ownership.

Methodology/Approach: Five search strategies plus inclusion and quality assessment criteria were applied to identify and select eligible studies. As a result, 50 studies were included in the review. Relevant findings were categorized as related to financial performance (profit margins, efficiency), employee well-being (staffing levels, turnover rates, job satisfaction, job benefits), or client well-being (care quality, hospitalization rates, lawsuits/complaints) and then analyzed based on common characteristics.

Findings: For-profit nursing homes tend to have better financial performance, but worse results with regard to employee well-being and client well-being, compared to not-for-profit sector homes. We argue that the better financial performance of for-profit nursing homes seems to be associated with worse employee and client well-being.

Practical Implications: For policy makers considering the expansion of the for-profit sector in the nursing home industry, our findings suggest the need for a broad perspective, simultaneously weighing the potential benefits and drawbacks for the organization, its employees, and its clients.

Aline Bos, MSc, is PhD Student, Utrecht University School of Governance, the Netherlands. E-mail:

Paul Boselie, PhD, is Professor of Strategic Human Resource Management, Utrecht University School of Governance, the Netherlands.

Margo Trappenburg, PhD, is Professor of Social work, University of Humanistic Studies, Utrecht, the Netherlands, and Associate Professor, Utrecht University School of Governance, the Netherlands.

This research received no specific grant from any funding agency in the public, commercial, or NFP sectors. The Appendices A and B, as referred to in the article, are available online as supplemental digital content.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved