Effects of Proprietary vs. Non-profit Nursing Home Ownership Type on Staff Working Conditions, Treatment, and Experience

Abstract

Since the 1930s, there has been ongoing research regarding the growth of proprietary nursing homes and nursing home chains (Gray, 1986). Unfortunately, the growth of the nursing home industry and the different types of ownership have led to disparities in care, quality, costs, and access to long-term care (You et al, 2016). Existing research mainly focuses on the impact that proprietary and non-profit facilities have on disparities in the quality of care that nursing home residents receive (Braun et al, 2021).

This thesis investigates how the ownership type of a nursing home affects the staff working in facilities across the country from the mid-twentieth century to the present COVID-19 dominated world. The staff of nursing homes—who are predominantly women of color—are often overlooked when it comes to analyzing the impact of ownership, a factor I argue to be a key contributor to the quality of care received by the residents in these facilities (Machledt, 2020). Through a series of ten interviews with a variety of people working with non-profit and proprietary nursing homes, I identify specific factors that affect the staff’s ability to provide high-quality care.

My research question explores two main aspects of the nursing home industry as it relates to the staff. Firstly, I study how the working conditions, treatment, and experiences of the staff affect their ability to provide high-quality care. I specifically analyze work hours, compensation rates, access to benefits, relationships between staff and residents, and cultural aspects that impact the staff’s daily work. Secondly, I investigate how the staff’s working conditions, treatment, and experiences are impacted based on the ownership type of the facility they work in.

To fully grasp these two crucial pieces of my research, I begin by reviewing existing literature on the differences between proprietary and non-profit nursing homes. Previous research highlights inconsistencies in the quality of care received at these facilities before and during the COVID-19 pandemic. Next, I delineate my methodology, research question, and research design. The following chapter analyzes the results from my interviews with industry professionals, followed by a discussion of several implications and limitations of my research. This thesis concludes with three policy recommendations aimed at improving the nursing home industry and alleviating disparities between ownership types. The first policy recommendation is to strengthen the current qualifications for an individual to own a nursing home by adding an additional five years of required experience in the industry. The second recommendation is to establish a required minimum percentage of full-time staff, while the other percentage can be from an agency or part-time staff. The final recommendation is to increase Medicaid reimbursement rates for nursing homes. The adoption of these policies will lead to higher quality care, better outcomes for residents, and a more stable nursing home industry.