Is quality really better in not-for-profit nursing homes?

Canadian researchers published a study in the British Medical Journal (view story here) in which they examined 82 studies carried out in the United States and Canada from 1965 to 2003 comparing quality between for-profit and not-for-profit nursing homes. Forty studies showed significantly better quality in not-for-profit homes and three showed the quality was better in for-profit homes. The remaining studies, however, had mixed results. Quality was judged on overall and quality of staffing, incidence of pressure ulcers, use of restraints, and inspection surveys. The analysis found that nursing home residents in the United States would receive 500,000 more hours of nursing care per day if all not-for-profit institutions provided all nursing home care.

The mission versus margin argument in healthcare is a long and complex one, and I am not here to debate that. What I do encourage is dialogue especially, from for-profits that have good indicators. Unless you start telling your story, studies like this will continue to paint the wrong picture. A more systemic issue in all this is staffing. All the other indicators can eventually be traced backed to good or poor staffing. Part of the problem is that the lowest tier worker in long-term care mostly views this as a job. If Target paid a buck more an hour they would be gone. The industry needs to create a culture where these are not jobs but mission driven careers. Of course salary becomes part of the attraction and recruitment. That we have two separate bodies representing nursing homes tells us something about how un-united we are and how far we need to come. Let’s start the dialogue.

Anthony Cirillo, FACHE, ABC, is a marketing consultant, professional speaker, aging and senior health expert, and the owner of Fast Forward Consulting. Visit his personal blog at


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