1. For-Profit Care and Quality: An Oxymoron? Joel Lexchin School of Health Policy and Management York University

2. Newly Admitted Residents Residents admitted to for-profit, independently owned facilities were younger, took fewer medications and had fewer falls in the 30 day prior to admission

3. Post-Acute Care Residents

4. Antipsychotic Prescribing Manitoba – Odds of being dispensed antipsychotic medications were 1.7 times greater for residents of for-profit homes in the Winnipeg Regional Health Authority versus not-for-profit and public homes in Manitoba Minnesota – Medicare and Medicaid certified for-profit facilities had higher antipsychotic use rates than did not-for-profit facilities United States – All 14,631 Medicare and Medicaid certified homes – Antipsychotic use was higher in those operated on a for- profit basis versus those on a not-for-profit basis

5. Overall Level of Care British Columbia (Canada) for-profit versus not-for-profit facilities – Higher adjusted hospitalization rates for pneumonia, anemia, and dehydration – No difference for falls, urinary tract infections, or decubitus ulcers/gangrene – No difference in mortality rates Two meta-analyses (American data) – “systematic differences exist between for-profit and not-for-profit nursing homes. For profit nursing homes appear to provide lower quality of care in many important areas of process and outcome” – Not-for-profit facilities delivered higher quality care than did for-profit facilities for two of the four most frequently reported quality measures” and for the two others there were non-significant results favouring not-for-profit homes

6. Outside North America (Israel) Scores adjusted for daily paid rate, institutional size & staffing level

7. Amount of Care By Type of Ownership

8. For-Profit Status or Other Factors? US study looking at pressure ulcers – May not be profit status but the extent to which practice environment supports staff nurses Poorer performance among US for-profit homes may relate to them having lower occupancy, higher Medicaid census, and operating in US states with lower Medicaid payments compared to not-for-profit homes – Higher percent Medicaid residents and lower payments put fiscal pressures on both for-profit and not-for profit homes – Restraint use increased and nursing levels decreased in both types of homes

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