title: Hospitalization and Mortality Rates in Long-Term Care Facilities: Does For-Profit Status Matter?
abstract: OBJECTIVE
  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.
authors.affiliation: 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.
authors.forename: Peter
authors.initials: P
authors.lastname: Tanuseputro
authors.affiliation: Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Chalifoux
authors.affiliation: Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada.
authors.forename: Carol
authors.initials: C
authors.lastname: Bennett
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Bronskill
authors.affiliation: Bruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Walker
authors.affiliation: 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.
authors.forename: Douglas
authors.initials: D
authors.lastname: Manuel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D009939:Organizations, Nonprofit; D017149:Private Sector; D019984:Quality Indicators, Health Care; D012112:Residential Facilities; D012189:Retrospective Studies; D055815:Young Adult
keywords: Nursing homes; hospitalization; long-term care; mortality; nonprofit organizations; proprietary; quality indicators