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J Am Med Dir Assoc. 2015 Oct 1;16(10):874-83. doi: 10.1016/j.jamda.2015.06.004.

Hospitalization and Mortality Rates in Long-Term Care Facilities: Does For-Profit Status Matter?

Author information

1
Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada. Electronic address: peter.tanuseputro@mail.utoronto.ca.
2
Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada.
3
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
4
Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa Hospital, Ottawa, Ontario, Canada.
5
Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.

Abstract

OBJECTIVES:

To establish if proprietary status (ie, for-profit or not-for-profit) is associated with mortality and hospitalizations among publicly funded long-term care (nursing) homes.

METHODS:

We conducted a retrospective cohort study of new admissions in 640 publicly funded long-term care facilities in Ontario, Canada (384 for-profit, 256 not-for-profit). A population-based cohort of 53,739 incident admissions into long-term care facilities between January 1, 2010, and March 1, 2012, was observed. We measured adjusted rates of hospital admissions and mortality, per 1000 person-years (PY) of follow-up, among for-profit and not-for-profit facilities at 3, 6, and 12 months postadmission. Rates were measured postadmission and until discharge or death, whichever came first.

RESULTS:

One year after admission and before discharge, 11.7% of residents died and 25.7% had at least one hospitalization. After 12 months of follow-up, residents in for-profit facilities had a hospitalization rate of 462 per 1000 PY versus 358 per 1000 PY in not-for-profit facilities. During this period, the crude mortality rate in for-profit facilities was 208 per 1000 PY versus 185 per 1000 PY in not-for-profit facilities. At 3, 6, and 1 year after admission, for-profit facilities had an adjusted hazard ratio of 1.36 (95% confidence interval [CI] 1.28-1.43), 1.33 (95% CI 1.27-1.39), and 1.25 (95% CI 1.21-1.30) for hospitalizations and hazards of 1.20 (95% CI 1.11-1.29), 1.16 (95% CI 1.09-1.24), and 1.10 (95% CI 1.05-1.16) for mortality, respectively.

CONCLUSIONS:

Publicly funded for-profit facilities have significantly higher rates of both mortality and hospital admissions.

KEYWORDS:

Nursing homes; hospitalization; long-term care; mortality; nonprofit organizations; proprietary; quality indicators

PMID:
26433862
DOI:
10.1016/j.jamda.2015.06.004
[Indexed for MEDLINE]
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