CMAJ • March 1, 2005; 172 (5). doi:10.1503/cmaj.1040131.
© 2005 CMA Media Inc. or its licensors
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Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter?

Margaret J. McGregor, Marcy Cohen, Kimberlyn McGrail, Anne Marie Broemeling, Reva N. Adler, Michael Schulzer, Lisa Ronald, Yuri Cvitkovich and Mary Beck

From the Department of Family Practice, University of British Columbia (McGregor), the Canadian Centre for Policy Alternatives (Cohen), the Centre for Health Services and Policy Research, University of British Columbia (McGrail, Broemeling, Ronald), the Department of Geriatric Medicine, University of British Columbia (Adler), the Centre for Clinical Epidemiology and Evaluation, Vancouver Hospital and Health Sciences Centre (McGregor, Schulzer), the Institution of Health Promotion Research, University of British Columbia (Cvitkovich), and the Health Sciences Department, Douglas College (Beck), Vancouver, BC

Correspondence to: Dr. Margaret J. McGregor, Mid-Main Community Health Centre, 3998 Main St., Vancouver BC V5V 3P2; fax 604-875-8790; mrgret{at}interchange.ubc.ca

Background: Currently there is a lot of debate about the advantages and disadvantages of for-profit health care delivery. We examined staffing ratios for direct-care and support staff in publicly funded not-for-profit and for-profit nursing homes in British Columbia.

Methods: We obtained staffing data for 167 long-term care facilities and linked these to the type of facility and ownership of the facility. All staff were members of the same bargaining association and received identical wages in both not-for-profit and for-profit facilities. Similar public funding is provided to both types of facilities, although the amounts vary by the level of functional dependence of the residents. We compared the mean number of hours per resident-day provided by direct-care staff (registered nurses, licensed practical nurses and resident care aides) and support staff (housekeeping, dietary and laundry staff) in not-for-profit versus for-profit facilities, after adjusting for facility size (number of beds) and level of care.

Results: The nursing homes included in our study comprised 76% of all such facilities in the province. Of the 167 nursing homes examined, 109 (65%) were not-for-profit and 58 (35%) were for-profit; 24% of the for-profit homes were part of a chain, and the remaining homes were owned by a single operator. The mean number of hours per resident-day was higher in the not-for-profit facilities than in the for-profit facilities for both direct-care and support staff and for all facility levels of care. Compared with for-profit ownership, not-for-profit status was associated with an estimated 0.34 more hours per resident-day (95% confidence interval [CI] 0.18–0.49, p < 0.001) provided by direct-care staff and 0.23 more hours per resident-day (95% CI 0.15–0.30, p < 0.001) provided by support staff.

Interpretation: Not-for-profit facility ownership is associated with higher staffing levels. This finding suggests that public money used to provide care to frail eldery people purchases significantly fewer direct-care and support staff hours per resident-day in for-profit long-term care facilities than in not-for-profit facilities.




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Staffing Levels Long Term Care
Ed Helfrich
CMAJ, 31 Mar 2005 [Full text]