title: Low-Quality Nursing Homes Were More Likely Than Other Nursing Homes To Be Bought Or Sold By Chains In 1993-2010.
abstract: Two defining features of the nursing home industry are the tremendous churn in chain ownership and the perception of low-quality care at many facilities. We examined whether nursing homes that underwent chain-related transactions, such as mergers and acquisitions, experienced a larger number of health deficiency citations than nursing homes that maintained common ownership over the same period. Using facility-level data for the period 1993-2010, we found that those nursing homes that underwent chain-related transactions had more deficiency citations in the years preceding and following a transaction than those nursing homes that maintained common ownership. Thus, we did not find that these transactions led to a decline in quality. Instead, we found that chains targeted nursing homes that were already having quality problems and that these problems persisted after the transaction. Given the high frequency of nursing home chain transactions, policy makers will need to continue to invest in tracking, reporting, and overseeing these transactions. One important step would be to report more detailed data on chain ownership, transactions, and aggregate chain quality on the Nursing Home Compare website, the federal government's online report card for nursing homes.
authors.affiliation: David C. Grabowski (grabowski@med.harvard.edu) is a professor of health care policy at Harvard Medical School, in Boston, Massachusetts.
authors.forename: David C
authors.initials: DC
authors.lastname: Grabowski
authors.affiliation: Richard A. Hirth is a professor of health management and policy at the University of Michigan, in Ann Arbor.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hirth
authors.affiliation: Orna Intrator is a professor of public health sciences at the University of Rochester, in New York.
authors.forename: Orna
authors.initials: O
authors.lastname: Intrator
authors.affiliation: Yue Li is an associate professor of community and preventive medicine at the University of Rochester.
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.affiliation: John Richardson is a PhD candidate in health management and policy at the University of Michigan.
authors.forename: John
authors.initials: J
authors.lastname: Richardson
authors.affiliation: David G. Stevenson is an associate professor in the Department of Health Policy at Vanderbilt University School of Medicine, in Nashville, Tennessee.
authors.forename: David G
authors.initials: DG
authors.lastname: Stevenson
authors.affiliation: Qing Zheng is a PhD candidate in health management and policy at the University of Michigan.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zheng
authors.affiliation: Jane Banaszak-Holl is an associate professor of health management and policy at the University of Michigan.
authors.forename: Jane
authors.initials: J
authors.lastname: Banaszak-Holl
mesh_terms: D006273:Health Facility Merger / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D009735:Nursing Homes / Q000458:organization & administration / Q000639:trends*; D010067:Ownership / Q000191:economics* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000592:standards*; D011795:Surveys and Questionnaires
keywords: Business Of Health; Elderly; Long-Term Care; Organization and Delivery of Care