Families Prefer Non-Profit, Non-Chain Nursing Homes with Strong Staffing

Families of residents feel better about care in nursing homes if the property has a non-profit owner, features higher than average registered nurse (RN) staffing, and isn’t part of a chain — at least according to the results of a new study that attempts to quantify some of the more qualitative reasons why people choose certain long-term care options.

“Higher Medicare payor mix and lower acuity levels were also associated with higher satisfaction,” the researchers — led by Tetyana Shippee of the University of Minnesota School of Public Health — wrote in their findings, published in the Journal of Applied Gerontology. “Structural characteristics were also associated with higher satisfaction, and included smaller size, higher occupancy, not being owned by a for-profit, or being affiliated with a chain, and rural location.”

The federal government has taken great strides over the last decade to provide information on nursing home quality and performance to the general public, primarily through the Centers for Medicare & Medicaid Services’ (CMS) Nursing Home Compare site and the related Five-Star Quality Rating System.


But researchers have pointed out that these official sources don’t provide the kinds of statistics and reviews that families want most when determining where to send an older relative: A recent study from the United Hospital Fund, for instance, suggested that nursing homes risk increased rehospitalization rates when they don’t provide accurate, relevant information, such as visiting hours, hospital affiliation, and the availability of private rooms.

“I am committed to quality measurements, absolutely, in terms of a driver of improving patient safety and the delivery of health care services, on the one hand,” Lynn Rogut, director of quality measurement and care transformation at the New York City-based United Hospital Fund, told SNN last month. “And on the other hand, I totally believe that that information is not all that useful to consumers when they’re making health care decisions. These are decisions about the care they want to receive, or decisions about the providers they want to receive it from.”

Shippee’s research tracks some of those criteria, including family members’ perceptions of staff behavior, activities, and food, as well as overall cleanliness and whether residents’ autonomy was respected. The data came from a pair of state-level surveys conducted in Minnesota and Ohio, with more than 1,000 responses across the two.


In addition to non-profit and independent ownership, families seemed to prefer facilities that were in more isolated rural areas, as well as properties with fewer beds and generally higher occupancy rates. Strong staffing levels were also an indicator of family satisfaction, the team noted.

“Staffing was a consistent organizational factor associated with higher family satisfaction, with families more satisfied in facilities that have higher RN, CNA, and activities staffing,” they wrote.

Despite the variations, the authors concluded that families had good reviews for nursing home care across the board — with some consistent areas of improvement.

“Our findings show that family members are generally satisfied with NH quality and consistently rate satisfaction with the perceived attitudes of staff as the highest item across both states, with activities and food consistently lowest,” they wrote.

Written by Alex Spanko