Study Targets For-Profit Nursing Homes Over Higher Risk of Neglect

New research from the University of Illinois at Chicago suggests that residents in for-profit nursing homes have the highest risk of receiving neglect-related diagnoses, and its authors claim the industry needs stronger oversight across all facility types.

The team, led by Lee Friedman of UIC’s School of Public Health, looked at the records of about 1,100 people over the age of 60 who were discharged from hospitals in the Chicago area from 2007 to 2011. The majority had entered the hospital from home, while 49 came from assisted living communities, 369 lived in for-profit SNFs, and 61 lived in non-profits.

Friedman and the researchers then used an internally developed metric, the Clinical Signs of Neglect Scale, to assess whether the patients experienced harmful or abusive treatment leading up to their hospitalizations; the figure adds extra weight to diagnoses strongly associated with neglect, such as broken catheters or pressure ulcers, and puts less emphasis on dehydration and malnutrition — signs that are more weakly associated with likely neglect.


“Patients receiving care in for-profit institutions were diagnosed with substantially more clinical signs of neglect than patients residing in not-for-profit facilities and low-functioning, community-dwelling patients,” the researchers concluded. “As reported in prior research, for-profit facilities caring for the patients in this study were significantly inferior across nearly all staffing, capacity, and deficiency measures.”

In particular, “serious signs” of neglect were also more common among residents of for-profit facilities, including stage-three or four pressure ulcers and lack of access to medications aimed at managing chronic conditions.

Friedman and the team blamed pay disparity at for-profit SNFs for the findings.


“For-profit nursing facilities pay their high-level administrators more, and so the people actually providing the care are paid less than those working at nonprofit places,” Friedman said in a release announcing the results. “So staff at for-profit facilities are underpaid and need to take care of more residents, which leads to low morale for staff, and it’s the residents who suffer.”

The UIC team also pointed out that the amount of for-profit nursing homes nationwide has increased over the last decade, while more non-profit and government-run entities have seen small declines. But they also acknowledged that nationwide, the overall number of nursing home beds has dropped — despite the fact that the population continues to age.

“For-profit facilities help fill this void and are important to the overall capacity needs nationwide, but adequate oversight needs to be in place to guarantee that an increase in capacity does not occur at the expense of quality of care,” they concluded, adding that local enforcement agencies should receive appropriate staffing support and employees should receive quality assurance training.

Written by Alex Spanko

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