title: Nurse staffing and deficiencies in the largest for-profit nursing home chains and chains owned by private equity companies.
abstract: OBJECTIVE
  To compare staffing levels and deficiencies of the 10 largest U.S. for-profit nursing home chains with five other ownership groups and chain staffing and deficiencies before and after purchase by four private equity (PE) companies.
  
  
  METHODS
  Facilities for the largest for-profit chains were identified through Internet searches and company reports and matched with federal secondary data for 2003-2008 for each ownership group.
  
  
  METHODS
  Descriptive statistics and generalized estimation equation panel regression models examined staffing and deficiencies by ownership groups in the 2003-2008 period, controlling for facility characteristics, resident acuity, and market factors with state fixed effects.
  
  
  RESULTS
  The top 10 for-profit chains had lower registered nurse and total nurse staffing hours than government facilities, controlling for other factors. The top 10 chains received 36 percent higher deficiencies and 41 percent higher serious deficiencies than government facilities. Other for-profit facilities also had lower staffing and higher deficiencies than government facilities. The chains purchased by PE companies showed little change in staffing levels, but the number of deficiencies and serious deficiencies increased in some postpurchase years compared with the prepurchase period.
  
  
  CONCLUSIONS
  There is a need for greater study of large for-profit chains as well as those chains purchased by PE companies.
authors.affiliation: Department of Social & Behavioral Sciences, University of California, San Francisco, CA 94118, USA. charlene.harrington@ucsf.edu
authors.forename: Charlene
authors.initials: C
authors.lastname: Harrington
authors.forename: Brian
authors.initials: B
authors.lastname: Olney
authors.forename: Helen
authors.initials: H
authors.lastname: Carrillo
authors.forename: Taewoon
authors.initials: T
authors.lastname: Kang
mesh_terms: D006269:Health Facilities, Proprietary / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D009735:Nursing Homes / Q000458:organization & administration / Q000592:standards; D009740:Nursing Staff / Q000458:organization & administration / Q000592:standards / Q000600:supply & distribution*; D017149:Private Sector / Q000458:organization & administration / Q000592:standards; D019984:Quality Indicators, Health Care; D014481:United States; D000078329:Workforce
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