Abstract
Objective
Previous studies report higher hospitalization rates in for-profit compared with nonprofit
long-term care facilities (LTCFs), but have not included staffing data, a major potential
confounder. Our objective was to examine the effect of ownership on hospital admission
rates, after adjusting for facility staffing levels and other facility and resident
characteristics, in a large Canadian province (British Columbia).
Design
Retrospective cohort study.
Setting and Participants
Our cohort included individuals resident in a publicly funded LTCF in British Columbia
at any time between April 1, 2012 and March 31, 2016.
Measures
Health administrative data were extracted from multiple databases, including continuing
care, hospital discharge, and Minimum Data Set (MDS 2.0) assessment records. Cox extended
hazards regression was used to estimate hospitalization risk associated with facility-
and resident-level factors.
Results
The cohort included 49,799 residents in 304 LTCF facilities (116 publicly owned and
operated, 99 for-profit, and 89 nonprofit) over the study period. Hospitalization
risk was higher for residents in for-profit (adjusted hazard ratio [adjHR] 1.34; 95%
confidence interval [CI] 1.29–1.38) and nonprofit (adjHR 1.37; 95% CI 1.32–1.41) facilities
compared with publicly owned and operated facilities, after adjustment for staffing,
facility size, urban location, resident demographics, and case mix. Within subtypes,
risk was highest in single-site facilities: for-profit (adjHR 1.42; 95% CI 1.36–1.48)
and nonprofit (adjHR 1.38, 95% CI 1.33–1.44).
Conclusions and Implications
This is the first Canadian study using linked health data from hospital discharge
records, MDS 2.0, facility staffing, and ownership records to examine the adjusted
effect of facility ownership characteristics on hospital use of LTCF residents. We
found significantly lower adjHRs for hospital admission in publicly owned facilities
compared with both for-profit and nonprofit facilities. Our finding that publicly
owned facilities have lower hospital admission rates compared with for-profit and
nonprofit facilities can help inform decision-makers faced with the challenge of optimizing
care models in both nursing homes and hospitals as they build capacity to care for
aging populations.
Keywords
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Article info
Publication history
Published online: July 06, 2020
Footnotes
The authors declare no conflicts of interest.
Funding source: Seniors' Advocate Office, British Columbia Ministry of Health; Community Geriatrics, University of British Columbia, Department of Family Practice.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
