Major For-Profit Nursing Home Chains Skimp on Care Quality, Study Shows

The top ten for-profit nursing home chains in the United States provide a lesser quality of care to their patients, partially due to fewer nursing staffing hours, according to a recent study published in Health Services Research.

Nurse “staffing hours” in the largest for-profit chains were 30% lower than those in non-profit and government nursing homes between 2003 and 2008. At the same time, the for-profits had the sickest residents, and maintained total nursing staff levels significantly lower than 2008’s national average of 3.77.

“Nurse staffing levels have been documented to have a positive impact on both the process and the outcomes of nursing home care,” report the study’s authors.


Although the staffing levels were low in comparison to non-profit and government facilities, they were still higher than other for-profit chains and for-profit nonchains, the study found.

However, when compared to top-rated nursing homes, the top-ten chains were cited for 41% more serious deficiencies and 36% more deficiencies overall. The average number of total and serious deficiencies was “significantly higher than in any other ownership group,” although other for-profit chains and nonchains also had higher deficiencies than government facilities.

“Facility size and the percent Medicaid residents were positively associated with total deficiencies and serious deficiencies,” said the study.


This is the first study that looks at staffing in conjunction with quality of care in the largest for-profit chains, and the results show that there’s a relationship between ownership, low staffing and higher deficiencies, the study’s authors concluded.

“The study does provide evidence of the need for more study of quality of care in the largest for-profit chains and in chains purchased by private equity firms, because they are under pressure to improve shareholder and investor values, with little oversight by regulators,” they said.

The full article, “Nurse Staffing and Deficiencies in the Largest For-Profit Nursing Home Chains and Chains Owned by Private Equity Companies,” can be accessed here.

Written by Alyssa Gerace