“Home Sweet Home.” Public domain.

May 16, 2017; Columbus Dispatch

NPQ has written repeatedly about research that documents the differences between nonprofit and for-profit nursing homes and hospices. Many of the studies show that for-profits bill Medicare at far higher rates and provide a lower quality of service, in large part evidenced through staff to patient ratios. The business plans behind some of the for-profit operations also show that a healthy portion of the revenue is siphoned away by vendors that are related to (or owned by) the owners of those homes. However, this does not mean that nonprofit nursing homes are pure in comparison.

Although Ohio ranks sixth in the nation for number of individuals older than sixty-five years of age, a recently released study by the Scripps Gerontology Center at Miami University finds that its nursing homes fall short in critical areas.

Ohio nursing homes fall well below national standards in the ten quality indicators laid out in the Minimum Data Set (MDS) used by the federal Centers for Medicare and Medicaid Services (CMS). The MDS is part of a mandated process used to assess nursing home residents’ “physical and clinical conditions and abilities, as well as preferences and life care wishes.” Examples of categories included in the MDS include basic measurements of well-being such as psychosocial health, dental and oral health, nutritional data, and medication use.

Ohio is also taking steps to prevent such rankings and bad press from occurring again. For instance, Governor Kasich’s administration is pushing for legislation that would prevent guaranteed funding for nursing homes, instead creating a competitive market that incentivizes nursing facilities to maintain high quality services. While this may help, an interesting finding from this study is that nonprofit nursing homes have better outcomes than for-profit homes. The reason for this discrepancy could be twofold and possibly point to a solution for struggling facilities in Ohio.

First, nonprofit nursing homes have a higher staff-to-resident ratio. Since the number of nursing home staff is correlated with better outcomes, nonprofit facilities clearly had the edge here. It seems backward that a nonprofit would hire more staff than a for-profit business, since nonprofits are notorious for being cash-strapped. However, nonprofit nursing facilities are not driven to make a profit.

Along the same line, Nisha Hammel, director of advocacy for LeadingAge Ohio says, nonprofit nursing homes “spend a lot of time and dollars on innovation and looking at interventions that are not always traditional approaches, which have the impact of quality of care.” This makes sense, as all nonprofit staff know that organizations need to continually make improvements to programs and report outcomes that encourage grantors and funders to continue to support the organization.

While the Scripps analysis was based on 2013 data, and nursing homes in the state have since made progress in some areas, there is still much more room for improvement. Beverly Laubert, Ohio’s long-term-care ombudsman, wants “consumers to be expecting excellence.” She says, “Really, I think it can be boiled down to one thing. We need to do better in nursing homes in Ohio.”

This differential is also clear not only in nursing homes but also in home health care and hospice care.—Sheela Nimishakavi