Patient care may be worse at for-profit nursing homes

For-profit nursing homes are more likely to provide worse care than their nonprofit rivals, according to a USA Today analysis of the government's first ranking of nearly 16,000 nursing homes.

The new Zagat-like rating system, released Thursday by the Centers for Medicare & Medicaid Services, assigns homes one to five stars for their quality, staffing and health inspections, plus an overall score.

The scores reflect tens of thousands of inspection records, complaint investigations and quality measures, such as how many nursing staff hours were provided each day to patients, how many patients developed bedsores and how many were placed in restraints. Much of the survey data were collected in 2008.

Acting Medicare Administrator Kerry Weems says making the data available in an easy-to-understand five-star format should help prompt "a national conversation about nursing home quality" and will encourage lower performing homes to improve.

USA Today's analysis of the government data found:

Twenty-seven percent of the USA's 10,542 for-profit homes were one-star, compared with 13 percent of the 4,138 nonprofit homes.

Nineteen percent of nonprofit facilities got five stars, compared with 9 percent of for-profits. Most nonprofits are owned by corporations, while about one-fifth are run by faith-based groups.

Homes associated with hospitals ranked higher than those that were not.

The USA Today analysis is consistent with other research, says Charlene Harrington, professor emeritus of nursing at the University of California-San Francisco and a member of Medicare's technical advisory committee for the ratings. Studies show "a lot of the for-profit homes have low staffing, and it shows up in their quality," she says.

Thomas Hamilton of the Centers for Medicare & Medicaid Services, who led development of the rating system, says Medicare researchers worked for years to develop their formula and assembled the advisory panel over the summer to help finalize the ratings. Results will be updated at least quarterly.

Janet Wells, public policy director for the National Citizen Coalition for Nursing Home Reform, made up of consumer advocacy groups, says her group initially opposed ratings, fearing they would be inaccurate. Now her members give the agency "high marks" for helping to distinguish bad homes from good ones. "It's probably going to be most useful at the extremes," she says.