Nursing Home Care Quality Decreases After Facility Changes Ownership: Study

Facilities that are operated for-profit, located in urban areas or part of a larger chain are more likely to see drops in nursing home staffing and care ratings when transferred to new owners.

Following years of concerns about reports of nursing home neglect at some for-profit facilities, a new study indicates that residents are more likely to experience a lower overall quality of care after a nursing home undergoes ownership changes, especially if they are located in urban areas or part of a larger chain.

In a report published in the August 2024 issue of the Journal of the American Geriatrics Society, researchers indicate that many facilities with new ownership suffer a drop in their overall star ratings, which are used to gauge the quality of a nursing home’s care.

Using CMS data from 2016 to 2022, Kira L. Ryskina and a team of researchers from the University of Pennsylvania Medical Center in Philadelphia and the Department of Veterans Affairs focused on the quality of care provided at 15,000 nursing homes, and then identified 3,600 nursing homes that changed ownership during that period.

According to the findings, changing ownership negatively impacted both staffing ratings and health inspection ratings.

Other factors that were found to affect nursing home care quality included being part of a chain, being located in the south, having lower occupancy rates, housing a higher percentage of Medicaid residents, or including a higher percentage of non-white residents.

Researchers indicate that these results emphasize a need for greater transparency about changes in nursing home ownership, and highlight the substantial impact that low staffing and cutbacks may have on the quality of nursing home care provided for residents.

Nursing Home Quality Has Worsened Since COVID-19 Pandemic

Quality issues and understaffing problems have long plagued nursing homes and other long-term care facilities in the United States. In 2019, the Centers for Medicare and Medicaid Services (CMS) released a list of 400 nursing homes with serious safety problems that continually provide poor care.

The COVID-19 pandemic only worsened the nursing home care quality at many facilities, largely due to low staffing levels. Another CMS report indicated nursing homes lost half their staff during the pandemic, and many were unable to fill the open positions after the pandemic ended.

Furthermore, a 2023 study published by researchers from Johns Hopkins and UCLA linked low staffing levels in nursing homes to reduced quality of care and an increased risk of nursing home neglect injuries.

Other data has also indicated that patients living in privately owned facilities are more likely to suffer poor care overall.

To address some of these problems, CMS issued a final rule setting minimum staffing levels for facilities across the U.S. earlier this year.

“Nursing Home Compare ratings decreased slightly after a change in facility ownership, driven by lower staffing and health inspection ratings and mitigated somewhat by higher quality measure ratings,” Ryskina said in this new report. “These conflicting trends underscore the need for transparency around changes in facility ownership and a better understanding of consequences of changes in ownership that are salient to patients and families.”