Non-profit or for-profit? Quality in Long-Term Care Homes

February 11, 2011 – Capacity at long-term care facilities (LTC) will need to increase as the Canadian population ages and the number of older people no longer able to function independently increases. According to a recent study, Residential Long-term Care for Canadian Seniors, current trends suggest that by 2041 Canada will need 320,000 beds across the country, up from the current 200,000.

Expanding capacity is one thing, but according to the study’s authors, Margaret McGregor and Lisa Ronald, an equally important issue is the quality of care provided at LTC facilities.

The study examines the link between quality of care in LTC facilities as provided by not-for-profit homes and for-profit homes. For the most part, LTC services are publicly funded in Canada, but are delivered by a mix of public, nonprofit, and for-profit facilities.

The study examines whether the type of ownership matters for the quality of care delivered and concludes that for-profit facilities are likely to produce inferior outcomes to not-for-profit homes. The authors argue that staffing levels are one important indicator of quality, and as such, not-for-profit homes provide better – and more – staffing. The rationale, according to the authors is that, “one of the principal mechanisms for generating profit is reducing staffing levels, which results in inferior quality of care.”

The authors admit, however, that there are considerable methodological challenges associated with measuring the quality of care in LTC facilities. Simply, it is rather difficult to conclude that ownership type is directly related to quality of care.

Similarly, they admit to questioning whether “the existing research is sufficiently robust to allow us to draw conclusions on this question.” Adding that, “while the causal link between for-profit ownership and inferior quality of care does not imply that all for-profit facilities provide poor care, the evidence suggests that, as a group, such facilities are less likely to provide good care than nonprofit or public facilities.”

The conclusions in the study work in principle and only in reference to jurisdictions where there aren’t already legislated benchmarks that must be met by all LTC facilities. Ontario, for example, has a LTC Act that sets standards and regulations that must be met by not-for-profit and for-profit homes alike.

Indeed, the true question of quality has more to do with enforceable standards and regulations than type of ownership. Accordingly, many of the recommendations offered by the study indicate that government can ensure quality, independent of ownership of the homes. For one, the authors recommend legislated minimum staffing levels be adopted. They also argue for implementation of regular unannounced inspections conducted by trained inspectors.

McGregor warns that “as the elderly population increases, the need for residential long-term care will be greater and governments will be under growing pressure to ensure better quality services.” That is certainly true, but the biggest test of quality will be the willingness of provincial governments to enact and enforce standards of care for all residents of LTC facilities, regardless of private or public ownership.

To read the full study, click here

Keywords: long-term care, seniors, private, homes