scholarly journals How the logics of the market, bureaucracy, professionalism and care are reconciled in practice: an empirical ethics approach

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Florien M. Kruse ◽  
Wieke M. R. Ligtenberg ◽  
Anke J. M. Oerlemans ◽  
Stef Groenewoud ◽  
Patrick P. T. Jeurissen
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Qualitative Interviews ◽  
Theoretical Framework ◽  
Empirical Ethics ◽  
Nursing Home Care ◽  
Ethical Question ◽  
Non Profit ◽  
For Profit ◽  
Relationships Management

Abstract Background In the Netherlands, the for-profit sector has gained a substantial share of nursing home care within just a few years. The ethical question that arises from the growth of for-profit care is whether the market logic can be reconciled with the provision of healthcare. This question relates to the debate on the Moral Limits of Markets (MLM) and commodification of care. Methods The contribution of this study is twofold. Firstly, we construct a theoretical framework from existing literature; this theoretical framework differentiates four logics: the market, bureaucracy, professionalism, and care. Secondly, we follow an empirical ethics approach; we used three for-profit nursing homes as case studies and conducted qualitative interviews with various stakeholders. Results Four main insights emerge from our empirical study. Firstly, there are many aspects of the care relationship (e.g. care environment, personal relationships, management) and every aspect of the relationship should be considered because the four logics are reconciled differently for each aspect. The environment and conditions of for-profit nursing homes are especially commodified. Secondly, for-profit nursing homes pursue a different professional logic from the traditional, non-profit sector – one which is inspired by the logic of care and which contrasts with bureaucratic logic. However, insofar as professionals in for-profit homes are primarily responsive to residents’ wishes, the market logic also prevails. Thirdly, a multilevel approach is necessary to study the MLM in the care sector since the degree of commodification differs by level. Lastly, it is difficult for the market to engineer social cohesion among the residents of nursing homes. Conclusions The for-profit nursing home sector does embrace the logic of the market but reconciles it with other logics (i.e. logic of care and logic of professionalism). Importantly, for-profit nursing homes have created an environment in which care professionals can provide person-oriented care, thereby reconciling the logic of the market with the logic of care.

scholarly journals For-Profit Nursing Homes in the Netherlands: What Factors Explain Their Rise?

2020 ◽  
Vol 50 (4) ◽  
pp. 431-443 ◽  
Author(s):  
Aline Bos ◽  
Florien Margareth Kruse ◽  
Patrick Paulus Theodoor Jeurissen
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
The Netherlands ◽  
Nonprofit Organizations ◽  
Private Equity ◽  
Nonprofit Sector ◽  
Nursing Home Care ◽  
Specialist Care ◽  
Labor Costs ◽  
For Profit

This exploratory, mixed-methods study analyzes characteristics of the emerging for-profit nursing home industry in the Netherlands and identifies the interrelated set of factors (context, trends, and sector conditions) that contribute to its growth. Until recently, the Dutch nursing home sector relied almost exclusively on nonprofit providers. Even though profit distribution in nursing home care is still banned, the for-profit nursing home sector is expanding. The study uses economic theory on nonprofit organizations and mixed-form markets to understand this expansion. We find that changes in the regulatory framework have unlocked the potential of the for-profit nursing home sector, enabling for-profit nursing homes to circumvent the for-profit ban. The expansion of the for-profit sector was mainly driven by the low responsiveness of the nonprofit sector to increased and changed demands. For-profit providers took advantage of this void. Moreover, they exploited “cream-skimming” potential in the market and used the wider care system to reduce their labor costs by relying on external specialist care. Another main driver was the access to financial capital from private investors (e.g., private equity firms).

scholarly journals For-profit nursing homes and the risk of COVID-19 outbreaks and resident deaths in Ontario, Canada

2020 ◽  
Author(s):  
Nathan M. Stall ◽  
Aaron Jones ◽  
Kevin A. Brown ◽  
Paula A. Rochon ◽  
Andrew P. Costa
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Case Fatality ◽  
Design Standards ◽  
Term Care ◽  
Process Measures ◽  
Non Profit ◽  
Adjusted Risk ◽  
For Profit ◽  
Profit Status

AbstractBackgroundNursing homes have become the epicentre of the coronavirus disease 2019 (COVID-19) pandemic in Canada. Previous research demonstrates that for-profit nursing homes deliver inferior care across a variety of outcome and process measures, raising the question of whether for-profit homes have had worse COVID-19 outcomes than non-profit homes.MethodsWe conducted a retrospective cohort study of all nursing homes in Ontario, Canada from March 29-May 20, 2020 using a COVID-19 outbreak database maintained by the Ontario Ministry of Long-Term Care. We used hierarchical logistic and count-based methods to model the associations between nursing home profit status (for-profit, non-profit or municipal) and nursing home COVID-19 outbreaks, COVID-19 outbreak sizes, and COVID-19 resident deaths.ResultsThe analysis included all 623 Ontario nursing homes, of which 360 (57.7%) were for-profit, 162 (26.0%) were non-profit, and 101 (16.2%) were municipal homes. There were 190 (30.5%) COVID-19 nursing home outbreaks involving 5218 residents (mean of 27.5 ± 41.3 residents per home), resulting in 1452 deaths (mean of 7.6 ± 12.7 residents per home) with an overall case fatality rate of 27.8%. The odds of a COVID-19 outbreak was associated with the incidence of COVID-19 in the health region surrounding a nursing home (adjusted odds ratio [aOR], 1.94; 95% confidence interval [CI] 1.23-3.09) and number of beds (aOR, 1.40; 95% CI 1.20-1.63), but not profit status. For-profit status was associated with both the size of a nursing home outbreak (adjusted risk ratio [aRR], 1.96; 95% CI 1.26-3.05) and the number of resident deaths (aRR, 1.78; 95% CI 1.03-3.07), compared to non-profit homes. These associations were mediated by a higher prevalence of older nursing home design standards in for-profit homes.Interpretation: For-profit status is associated with the size of a COVID-19 nursing home outbreak and the number of resident deaths, but not the likelihood of outbreaks. Differences between for profit and non-profit homes are largely explained by older design standards, which should be a focus of infection control efforts and future policy.

scholarly journals A Stage Set for Disaster: For-Profit Nursing Homes, Federal Law, and COVID-19

2021 ◽  
Vol 1 (3) ◽  
Author(s):  
David Papke
Keyword(s):  
United States ◽  
Twentieth Century ◽  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
The United States ◽  
Nursing Home Care ◽  
Federal Law ◽  
For Profit

This article exposes the tragic relationship between for-profit nursing homes and the spread of COVID-19 in those facilities. For-profit nursing homes came to dominate nursing-home care in the United States in the second half of the twentieth century. However, for-profit nursing homes on average provided care which was inferior to the care provided in state-run and nonprofit nursing homes. Congress attempted to address the problems in nursing homes in the final decades of the twentieth century, but massive statutes and abundant regulations served mostly to legitimize for-profit nursing homes. COVID-19 then underscored the flaws in the legally sanctioned, for-profit nursing homes, as thousands died within the problematic institution’s walls.

scholarly journals Profit Status and Employee Turnover in Iowa Nursing Homes

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 570-571
Author(s):  
Hari Sharma ◽  
Lili Xu
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Employee Turnover ◽  
Older Individuals ◽  
High Turnover ◽  
Non Profit ◽  
For Profit ◽  
Percentage Points ◽  
Nursing Home Quality ◽  
Profit Status

Abstract Employee turnover is a huge concern for nursing homes that care for millions of older individuals whose physical and cognitive impairments make them vulnerable, especially in the middle of a pandemic like COVID-19. Existing research has shown that high turnover of employees can lead to poorer quality of care. Low pay is often cited as one of the key reasons for high turnover of employees in nursing homes. For-profit nursing homes may try to maximize profits by limiting wages paid to their employees. In this study, we examine whether profit-status of a facility is associated with high turnover of its employees. We obtain data on 415 nursing homes operating in Iowa between 2013-2017. We descriptively examine the turnover trends in nurse employees and all employees over time by profit status. We evaluate whether profit status is associated with high turnover using pooled linear regressions controlling for nursing home and resident characteristics. Descriptive results show that for-profit facilities had higher turnover of nurse employees (61.1% vs. 49.6%) and all employees (56.6% vs. 45.4%). Results from multivariate regressions show that, compared to non-profit facilities, for-profit facilities had 6.93 percentage points higher (p<0.01) turnover of all employees, and 7.76 percentage points higher (p<0.01) turnover of nurse employees after controlling for facility and resident characteristics. Given existing evidence on the adverse impact of high employee turnover on nursing home quality, we need policies aimed at lowering employee turnover, targeting for-profit nursing homes.

The experiences, priorities, and perceptions of informal caregivers of people with dementia in nursing homes: A scoping review

Dementia ◽  
2021 ◽  
pp. 147130122110126
Author(s):  
Alexandra E Harper ◽  
Lauren Terhorst ◽  
Marybeth Moscirella ◽  
Rose L Turner ◽  
Catherine V Piersol ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
Scoping Review ◽  
Informal Caregivers ◽  
Nursing Home Care ◽  
Person Centered Care ◽  
People With Dementia ◽  
Centered Care

Background Person-centered care has been shown to increase desired outcomes for people with dementia, yet informal caregivers’ dissatisfaction with care is often reported. For those living in a nursing home, informal caregivers are uniquely situated to provide key insights into the individual’s care. However, little is known of the informal caregivers’ perspective, which hinders efforts to improve their satisfaction with person-centered nursing home care. Thus, we examined the comprehensive experiences, priorities, and perceptions of informal caregivers of nursing home residents with dementia. Methods In collaboration with stakeholders, a scoping review of Medline (Ovid), EMBASE.com , CINAHL (EBSCO), the Cochrane Library (Wiley), and PsycINFO (Ovid) databases from January 2000 to July 2020 was conducted. Data were extracted reflecting the experiences, priorities, and preferences of caregivers of people with dementia residing in nursing homes. Results We identified 114 articles that revealed nine themes: (1) communication, (2) transition to nursing home, (3) quality of care, (4) quality of life, (5) informal caregiver role, (6) knowledge of dementia, (7) end-of-life preferences, (8) medication use to manage neuropsychiatric behaviors, and (9) finances. Conclusion Informal caregivers described aspects of care that led to both positive and negative experiences with and perceptions of nursing home care. The shortcomings in communication were discussed most frequently, indicating a high priority area. While researchers define the identified themes individually, informal caregivers perceive them to be interwoven as they relate to person-centered care delivery. Although we did not assess the quality of included articles, by identifying themes relevant to caregivers’ perspectives of nursing home care, our findings may help to inform efforts to optimize caregivers’ satisfaction with nursing home care for residents with dementia.

scholarly journals The Physical Environment of Nursing Homes for People with Dementia: Traditional Nursing Homes, Small-Scale Living Facilities, and Green Care Farms

Healthcare ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. 137 ◽  
Author(s):  
Bram de Boer ◽  
Hanneke Beerens ◽  
Melanie Katterbach ◽  
Martina Viduka ◽  
Bernadette Willemse ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Physical Environment ◽  
Well Being ◽  
Nursing Home Care ◽  
Small Scale ◽  
People With Dementia ◽  
Different Types ◽  
Centered Care ◽  
Green Care Farms

It is well recognized that the physical environment is important for the well-being of people with dementia. This influences developments within the nursing home care sector where there is an increasing interest in supporting person-centered care by using the physical environment. Innovations in nursing home design often focus on small-scale and homelike care environments. This study investigated: (1) the physical environment of different types of nursing homes, comparing traditional nursing homes with small-scale living facilities and green care farms; and (2) how the physical environment was being used in practice in terms of the location, engagement and social interaction of residents. Two observational studies were carried out. Results indicate that the physical environment of small-scale living facilities for people with dementia has the potential to be beneficial for resident’s daily life. However, having a potentially beneficial physical environment did not automatically lead to an optimal use of this environment, as some areas of a nursing home (e.g., outdoor areas) were not utilized. This study emphasizes the importance of nursing staff that provides residents with meaningful activities and stimulates residents to be active and use the physical environment to its full extent.

scholarly journals Malpractice Environment vs Direct Litigation: What Drives Nursing Home Exit?

2018 ◽  
Vol 55 ◽  
pp. 004695801878799
Author(s):  
R. Tamara Konetzka ◽  
Hari Sharma ◽  
Jeongyoung Park
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Fixed Effects ◽  
Online Survey ◽  
Market Competition ◽  
Consumer Welfare ◽  
Data Sets ◽  
For Profit ◽  
The Impact ◽  
The Relationship

An ongoing concern about medical malpractice litigation is that it may induce provider exit, potentially affecting consumer welfare. The nursing home sector is subject to substantial litigation activity but remains generally understudied in terms of the effects of litigation, due perhaps to a paucity of readily available data. In this article, we estimate the association between litigation and nursing home exit (closure or change in ownership), separating the impact of malpractice environment from direct litigation. We use 2 main data sources for this study: Westlaw’s Adverse Filings database (1997-2005) and Online Survey, Certification and Reporting data sets (1997-2005). We use probit models with state and year fixed effects to examine the relationship between litigation and the probability of nursing home closure or change in ownership with and without adjustment for malpractice environment. We examine the relationship on average and also stratify by profit status, chain membership, and market competition. We find that direct litigation against a nursing home has a nonsignificant effect on the probability of closure or change in ownership within the subsequent 2 years. In contrast, the broader malpractice environment has a significant effect on change in ownership, even for nursing homes that have not been sued, but not on closure. Effects are stronger among for-profit and chain facilities and those in more competitive markets. A high-risk malpractice environment is associated with change of ownership of nursing homes regardless of whether they have been directly sued, indicating that it is too blunt an instrument for weeding out low-quality nursing homes.

Families, Alzheimer's Disease, and Nursing Homes

1988 ◽  
Vol 7 (3) ◽  
pp. 331-349 ◽  
Author(s):  
Nathan L. Linsk ◽  
Baila Miller ◽  
Roberta Pflaum ◽  
Anna Ortigara-Vicik
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Nursing Homes ◽  
Care Center ◽  
Family Members ◽  
Nursing Home Care ◽  
Demonstration Program ◽  
Home Setting

The Alzheimer's Disease Family Care Center program was established within an intermediate care teaching nursing home as a demonstration program to investigate ways to involve families in care of their relatives. In total, 45 family members participated in a program including an orientation session; a preliminary family involvement interview; contracts with family members, in which they chose specific tasks to engage in during visits; a five-session course on Alzheimer's disease and how families may be partners in care within the facility; and an ongoing family support group. Evaluation data sources include a baseline and 9-month follow-up questionnaire completed by families, preliminary and follow-up family interviews conducted by project codirectors, records of family visits, and family choices on contracts. Findings from the 23 family members who contracted for tasks during their visits and from the follow-up questionnaire completed by 25 family members showed that most sought social and emotional interactions with relatives, some maintained direct personal care activities, and only a few identified interest in extensive involvement with staff and facility. At follow-up, family members involved in the program reported they continued to feel close to their relatives. Many felt that their relatives were generally stable or improved with regard to cognitive function, but over a third noted difficulties in communicating. Participating family members reported that the program of staff supports helped them to feel more integral to the unit. They expressed a need for more education and support for their involvement in the nursing home setting. Project findings confirm previous studies recommending that programming at nursing homes needs to include specific institutional and staff supports to maintain and enhance family contributions to the long-term nursing home care of their relatives.

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