Previous studies have noted a lower quality of care in for-profit nursing homes, but those studies have typically focused on individual clinical effects. A new study looking at a broader list of neglect found that residents in for-profit homes are almost twice as likely to experience adverse health problems from substandard care.
Previous studies have noted a lower quality of care in for-profit nursing homes, but those studies have typically focused on individual clinical effects, like pressure sores. A new study looking at a broader list of neglect found the same association, and the authors called for more oversight, especially as the for-profit nursing home industry grows.
The study, which found that residents in for-profit homes are almost twice as likely to experience adverse health problems as a result of substandard care, was published recently in the journal Gerontology.
Patients included in the study were seen at 5 hospitals in the Chicago area between 2007 and 2011 for issues ranging from mild to severe that could be related to substandard care. The researchers assessed the relationship between residence type—community-dwelling, not-for-profit facility, for-profit facility—and clinical signs of neglect.
Community-dwelling residents live in private homes, often with family members or friends. The study also found that these residents, who need assistance with tasks related to daily living but do not live in a nursing home, had the fewest number of clinical signs of neglect compared with those living in any type of nursing facility.
The study included medical records for 1149 patients aged 60 and older. The researchers used the Clinical Signs of Neglect Scale (CSNS), which was developed by the lead author, Lee Friedman, PhD, associate professor of environmental and occupational health sciences the University of Illinois at Chicago School of Public Health, and his colleagues. The CSNS quantifies health problems related to substandard care and health outcomes among individuals they identified living in private homes, nonprofit nursing homes and for-profit nursing homes. The scale lists about 24 conditions, ranging from constipation and dehydration to more serious issues such as severe bed sores and broken catheter tubes.
Individual clinical signs of neglect like sores or injuries rarely occur by themselves, so past studies that only included those factors likely underestimated the scope of the problem, the researchers said.
"We saw more—and more serious—diagnoses among residents of for-profit facilities that were consistent with severe clinical signs of neglect, including severe dehydration in clients with feeding tubes which should have been managed, clients with stage 3 and 4 bed sores, broken catheters and feeding tubes, and clients whose medication for chronic conditions was not being managed properly," Friedman said in a statement.
Relative to low-functioning community-dwelling patients, the mean difference in CSNS scores was higher among patients residing in not-for-profit facilities by 1.99 (P = .012) and 3.55 (P ≤.001) among patients in for-profit facilities. In a separate model, the mean difference in CSNS scores among patients living in for-profit facilities compared to not-for-profit facilities was 1.90 (P = .035).
Part of the problem, Friedman said, is that administrators in for-profit homes are paid more, and staff at non-for-profit homes are underpaid. Staffing levels at for-profit homes may also be lower.
Neglect can be hard to detect, the authors wrote, but without improved identification and reporting, it will be difficult to protect patients. A typical scenario is that a nursing home patient will be sent to a hospital, where substandard care is not recognized. The patient improves and is returned to the home, only to return again.
The problem is starting to become recognized, though. Kaiser Health News recently reported that, starting this month, Centers for Medicare and Medicaid Services will begin handing out bonuses or penalties to nursing homes based on their hospital readmission rates.
The authors cited several factors that are barriers to improved screening within hospitals:
"There needs to be better staffing and training for enforcing these measures. Performance improvement programs and quality assurance and assessment committees, tighter adherence to federal law by Central Management Services that ties Medicare and Medicaid reimbursement with quality of care, and pressure from insurance providers to limit costly outcomes could help reduce the unfortunate diagnoses we saw in our study,” said Friedman.
The issue of oversight is key because, while Americans are aging, there has been a small decline in the quantity of overall nursing home beds, as the number of government and not-for-profit nursing homes has fallen over the past 10 years, the study said.
The study had several limitations, although the authors said the design mitigated some of them. For instance, the referral patterns of patients to hospitals may differ in not-for-profit and for-profit facilities, but the authors said that inclusion criteria were not based on place of residence. In addition, the 5 hospitals have very large catchment areas that cover approximately 10% of all inpatient cases statewide. And since nursing homes are more likely to treat persons with functional limitations, or terminal patients with clinical signs treated as outcomes in this study, the authors included days of follow-up.
Reference
Friedman L, Avila S, Friedman D, Meltzer W. Association between type of residence and clinical signs of neglect in older adults. [published online October 9, 2018]. Gerontology. doi: 10.1159/000492029.
Specialty Pharmacists at the Forefront: Elevating Care for Rare Diseases
May 1st 2024In the US, a disease is considered rare when it affects fewer than 200,000 persons, or 1 in every 1500 individuals, with an estimated total of 25 to 30 million Americans overall living with a rare disease at any given time.
Read More
Tackling Health Inequality: The Power of Education and Experience
April 30th 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our final episode of this limited series and our conversation with Janine Jelks-Seale, MSPPM, director of health equity at UPMC Health Plan.
Listen
Latest Advances and Updates of Treatment in the Real World at AUA
May 1st 2024The annual meeting of the American Urological Association (AUA) not only presents the newest therapies coming out but showcases the latest in how treatments are being used in the real world, said Stephen Freedland, MD, of Cedars Sinai.
Read More
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
BRCA-Like Classification May Be a Useful Biomarker for Olaparib Response in Ovarian Cancer
May 1st 2024Adding olaparib to maintenance therapy with bevacizumab was associated with significantly longer survival for patients with ovarian cancer whose tumors have a BRCA-like genomic profile, but not among those with non-BRCA-like tumors, a study found.
Read More