Several states such as New York have enacted rules to oversee (and potentially limit) for-profit nursing home entry. First, from the perspective of public policy, state and federal policy makers are asked to make decisions exactly on these changes. Previous research has not directly tested whether conversions across ownership form have implications for attributes of nursing home behavior such as quality of care.Ī study of ownership conversions is potentially compelling on two levels ( Picone, Chou, and Sloan 2002). These conversions may affect a facility's administrative and nursing staff turnover, access to capital, willingness to accept less profitable patients, and overall quality of care. Although the majority of facility transactions occur within ownership type, there were nearly 3,000 conversions across for-profit, nonprofit, and government status over the period 1993–2004, with a large increase in the latter part of the period. The last decade has been a period of tremendous change within the nursing home sector, with many of the nation's largest nursing home chains going through periods of considerable expansion and contraction ( Stevenson, Grabowski, and Coots 2006). However, this previous literature is based almost entirely on cross-sectional comparisons of nonprofit and for-profit nursing homes. (2005) concluded that quality was lower in for-profit nursing homes. In a comprehensive literature review of 38 studies published over the period 1990–2002, Hillmer et al. Given that nearly two-thirds of nursing homes are for-profit owned, there has been an interest among researchers and policy makers in establishing a causal link between ownership status and quality of care. Quality has been a long standing policy issue in the nursing home sector with over three decades of research establishing substandard care practices in particular facilities ( Institute of Medicine 2001).
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