title: Do Nursing Home Chain Size and Proprietary Status Affect Experiences With Care?
abstract: BACKGROUND
  In 2012, over half of nursing homes were operated by corporate chains. Facilities owned by the largest for-profit chains were reported to have lower quality of care. However, it is unknown how nursing home chain ownerships are related with experiences of care.
  
  
  OBJECTIVE
  To study the relationship between nursing home chain characteristics (chain size and profit status) with patients' family member reported ratings on experiences with care.
  
  
  METHODS
  Maryland nursing home care experience reports, the Online Survey, Certification, And Reporting (OSCAR) files, and Area Resource Files are used. Our sample consists of all nongovernmental nursing homes in Maryland from 2007 to 2010. Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food and meals; physical environment; and autonomy and personal rights. We identified chain characteristics from OSCAR, and estimated multivariate random effect linear models to test the effects of chain ownership on care experience ratings.
  
  
  RESULTS
  Independent nonprofit nursing homes have the highest overall rating score of 8.9, followed by 8.6 for facilities in small nonprofit chains, and 8.5 for independent for-profit facilities. Facilities in small, medium, and large for-profit chains have even lower overall ratings of 8.2, 7.9, and 8.0, respectively. We find similar patterns of differences in terms of recommendation rate, and important areas such as staff communication and quality of care.
  
  
  CONCLUSIONS
  Evidence suggests that Maryland nursing homes affiliated with large-for-profit and medium-for-profit chains had lower ratings of family reported experience with care.
authors.affiliation: *Department of Economics, University at Albany, State University of New York, Albany †Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center, Rochester, NY ‡Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN §Department of Health Management and Policy, University of Michigan, Ann Arbor, MI ∥Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors.forename: Kai
authors.initials: K
authors.lastname: You
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.forename: Orna
authors.initials: O
authors.lastname: Intrator
authors.forename: David
authors.initials: D
authors.lastname: Stevenson
authors.forename: Richard
authors.initials: R
authors.lastname: Hirth
authors.forename: David
authors.initials: D
authors.lastname: Grabowski
authors.forename: Jane
authors.initials: J
authors.lastname: Banaszak-Holl
mesh_terms: D004777:Environment; D005522:Food Services / Q000592:standards / Q000706:statistics & numerical data; D006269:Health Facilities, Proprietary / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care; D008396:Maryland; D009735:Nursing Homes / Q000458:organization & administration* / Q000706:statistics & numerical data*; D009939:Organizations, Nonprofit / Q000458:organization & administration / Q000706:statistics & numerical data; D028701:Patient Rights; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D026684:Personal Autonomy; D010561:Personnel Staffing and Scheduling; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012959:Socioeconomic Factors