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Consumers need a way to distinguish good from bad institutional care.

It’s one of the most wrenching of life’s decisions: a beloved parent can no longer care for herself, and you must place her in a nursing home. The choices are bewildering. At first glance, it might seem that the management practices used by chain-owned nursing homes might improve services, because corporate owners can standardize both clinical and administrative functions to improve efficiency. But as Jane Banaszak-Holl and a team of researchers have found, that’s not always the case. In fact, too much standardization can hurt resident care.

“Consumers need ways to identify what is a good or bad nursing home,” says Banaszak-Holl, associate professor of health management and policy and co-author of a new study on the management structure of nursing homes. “Right now, we have an easier time distinguishing the quality in McDonald’s versus Boston Market than we have comparing nursing-home chains.”

Chain-owned nursing homes are the predominant type of institutional care in the United States, and they have a reputation for providing substandard care. That’s because one of the strengths of a nursing home chain—its ability to standardize—can also be a weakness. If too much emphasis is placed on administrative standards, such as marketing and strategic planning, to the detriment of clinical and facility standards, such as treatment guidelines and facility layout, resident care suffers.

“Chain ownership is not necessarily bad for the quality of health care,” Banaszak-Holl points out. “What is problematic is a shift away from community values and local needs, and an overly strong emphasis on administrative rather than clinical outcomes.” She and her fellow researchers recommend that chains balance administrative efficiency with the local needs of individual chain-owned facilities. “A good corporate chain can implement a set of practices that still attends to local needs and resident outcomes, while introducing greater economies of scale and better business practices.”

To learn more:
www.cdc.gov/nchs/fastats/nursingh.htm (CDC National Center for Health Statistics, Nursing Home Care)
www.healthinaging.org (The American Geriatrics Society Foundation for Health in Aging)
www.nlm.nih.gov/medlineplus/nursinghomes.html (Medline Plus, Nursing Homes)

Send correspondence about this or any Findings article to the editor at sph.findings@umich.edu. You will be contacted if your letter is considered for publication.

factCHECK, 2007

> Of the approximately 17,000 nursing homes currently in the U.S., 65 percent are for-profit, 25 percent not-for-profit, and 10 percent government-owned.

> Fifty-six percent of nursing homes in the U.S. are part of a chain.

> In 2007, an estimated $150 billion will be spent on nursing-home care in the U.S.

> Without a breakthrough in the treatment of dementia, the number of people 65 and older living in nursing homes will likely double by the year 2020.