The role of ownership in the provision of nursing home care has long been a challenging issue for policymakers and researchers. Although much of the focus historically has been on differences between for-profit and not-for-profit facilities, this simple distinction has become less useful in recent years as companies have employed more complicated ownership and management structures. Using detailed ownership data from the State of Texas, we describe the evolution of nursing home corporate structures from 2000–2007, analyze the effect of these structures on quality of care and staffing in nursing homes, and discuss the policy implications of these changes.
The role of ownership in the provision of nursing home care has long been a challenging issue for policymakers and researchers. Historically, much of the focus in this area has been on for-profit providers, which have played a prominent role in the nursing home sector for decades. Nearly two-thirds of facilities in the United States currently operate on a proprietary basis, and many of these facilities operate as part of multi-facility chains. In the context of recurring quality of care problems, the role of for-profit companies often has been investigated as a possible contributing factor, and a large body of research has compared care delivered by for-profit and not-for-profit facilities
A key lynchpin in researching and enforcing policy directives around nursing home ownership is having timely, detailed data about ownership structures and management arrangements. Importantly, Federal datasets are not yet able to facilitate these tasks adequately. On-Line Survey Certification and Reporting (OSCAR) data offer only cursory information about ownership, including for-profit and chain status and, where relevant, the name and organizational type of the parent company. Even the straightforward task of identifying facilities with the same chain owner can be difficult with OSCAR data, as this field in the database is an open-ended text field subject to slight variations and errors in data entry. In addition, the Provider Enrollment, Chain, and Ownership System (PECOS) data have faced multiple implementation challenges to date and have not yet fulfilled their purpose to provide detailed information on ownership structures and changes over time.