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Do Nursing Home Chain Size and Proprietary Status Affect Experiences With Care?

You, Kai MS; Li, Yue PhD; Intrator, Orna PhD; Stevenson, David PhD; Hirth, Richard PhD; Grabowski, David PhD; Banaszak-Holl, Jane PhD

doi: 10.1097/MLR.0000000000000479
Brief Report

Background: In 2012, over half of nursing homes were operated by corporate chains. Facilities owned by the largest for-profit chains were reported to have lower quality of care. However, it is unknown how nursing home chain ownerships are related with experiences of care.

Objectives: To study the relationship between nursing home chain characteristics (chain size and profit status) with patients’ family member reported ratings on experiences with care.

Data Sources and Study Design: Maryland nursing home care experience reports, the Online Survey, Certification, And Reporting (OSCAR) files, and Area Resource Files are used. Our sample consists of all nongovernmental nursing homes in Maryland from 2007 to 2010. Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food and meals; physical environment; and autonomy and personal rights. We identified chain characteristics from OSCAR, and estimated multivariate random effect linear models to test the effects of chain ownership on care experience ratings.

Results: Independent nonprofit nursing homes have the highest overall rating score of 8.9, followed by 8.6 for facilities in small nonprofit chains, and 8.5 for independent for-profit facilities. Facilities in small, medium, and large for-profit chains have even lower overall ratings of 8.2, 7.9, and 8.0, respectively. We find similar patterns of differences in terms of recommendation rate, and important areas such as staff communication and quality of care.

Conclusions: Evidence suggests that Maryland nursing homes affiliated with large-for-profit and medium-for-profit chains had lower ratings of family reported experience with care.

*Department of Economics, University at Albany, State University of New York, Albany

Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center, Rochester, NY

Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN

§Department of Health Management and Policy, University of Michigan, Ann Arbor, MI

Department of Health Care Policy, Harvard Medical School, Boston, MA

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Supported by the National Institute on Aging (NIA) under Grant R01AG042418. The views expressed in this article are those of the authors and do not necessarily represent the views of the NIA of the NIH. D.S. was supported by NIH-NIA K01 AG038481.

The authors declare no conflict of interest.

Reprints: Kai You, MS, Department of Economics, Business Administration Building, Room 109, 1400 Washington Avenue, Albany, NY 12222. E-mail:

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