This study examines the differences in hospital admission rates between for-profit (FP) and not-for-profit (NP) long-term care facilities in British Columbia. The goal of the study was to determine whether quality of care is affected by the ownership of a long-term care facility. The results of the study indicate that after adjusting for age, gender, level of care and previous hospitalisations, hospitalisation rates were higher in FP facilities than NP facilities for three out of seven reasons for admission analysed. Results also showed that admission rates for all reasons were higher in FP facilities compared to NP facilities which were attached to a hospital. There were no significant differences in mortality rates between FP and NP facilities.

Background: Long-term care facilities provide care to individuals who are unable to function independently because of medical, physical or cognitive disabilities. In Canada, long-term care is delivered through both not-for profit (NP) and for-profit (FP) facilities. In British Columbia approximately 30% of publicly funded long-term care is delivered through FP facilities. Within the past five years, the number of publicly funded beds in FP long-term care facilities has been increasing in British Columbia, which raises the question, how comparable is the care in FP versus NP long-term care facilities. This study examines the difference in hospital admission rates (due to selected criteria which reflects facility care quality) between NP and FP long-term care facilities after adjustment for case mix and other individual and facility level factors.

Methods: Data for this study were taken from the British Columbia Linked Health Database, which includes records of publicly funded health care services use and vital statistics for all residents of British Columbia. The population studied included individuals who spent at least one day in a British Columbia long-term care facility between April 1, 1996 and August 1, 1999. This did not include individuals in mental health group homes, rehabilitation centres, palliative care centres or individuals who did not classify as needing a high level of care as determined by the province-wide classification system. Facility care quality was assessed based on hospital admissions with a primary diagnosis of: falls, pneumonia, anemia, urinary tract infections, dehydration, decubitus ulcers and/or gangrene. Death that occurred in hospital within 30 days of leaving a long-term care facility was also included.

Findings: The average age of participants in this study was 82.3 years, and there was no difference in average age between facility-types. Sixty-six percent of participants were women, and there was a slightly higher number of men in the NP facilities compared to the FP facilities. Also, there were twice as many extended level of care patients (those classified as needing the highest amount of care) in the NP facilities. Of the 301 long-term care facilities in British Columbia at the time of this study, 76% were NP. Hospitalisation rates for FP facilities were significantly higher than NP facilities for admissions for pneumonia, anemia, and dehydration, after adjusting for age, gender, level of care, and hospitalisation within the previous 30 days,. Four types of NP facilities were identified: attached to a hospital, owned and/or operated by a regional health authority, multisite (two or more facilities owned and operated by a NP community or religious society) and single-site (one site owned and operated by a NP community or religious society). Three types of FP facilities were identified: chains (facilities part of a larger corporate structure), multisite (non-corporate facilities with more than one site) and single-site (one non-corporate facility). When FP facilities were compared to the NP facilities attached to a hospital, hospitalisation rates for all of the diagnoses studied were significantly higher in the FP facilities. FP facility admission rates were also higher for most diagnoses compared to NP owned and/or operated by a regional health authority and NP multisite facilities. When looking at NP single-site facilities however, hospital admission rates were either the same or higher than in the FP facilities. There was no difference in mortality rates between NP and FP facilities.

Conclusions: The results of this study contribute to previous literature which has shown that residents in FP facilities are more likely to be hospitalised than residents in NP facilities. However, this study went further by showing that NP facilities, which are attached to hospitals are more likely to have lower hospital admission rates on all of the diagnoses followed in this study. The authors speculate that the lower hospital admission rates at NP facilities might be because of higher staffing rates, and better access to diagnosis equipment. However, single-site (non-corporate) NP facilities fared no better than FP facilities.

Reference: McGregor, M. J., Tate, R. B., McGrail, K. M., Ronald,L. A., Broemeling, A., & Cohen, M. "Care Outcomes in Long-Term Care Facilities in British Columbia, Canada: Does Ownership Matter?" Medical Care, 2006; 44 (10), 929-935.

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