Managerial Ownership in Nursing Homes: Staffing, Quality, and Financial Performance

Financial Performance is Associated With PPE Shortages in Chain-Affiliated Nursing Homes During the COVID-19 Pandemic: A Longitudinal Study

Many nursing homes operated at thin profit margins prior to the COVID-19 pandemic. This study examines the role of nursing homes' financial performance and chain affiliation in shortages of personal protection equipment (PPE) during the first year of the COVID-19 pandemic. We constructed a longitudinal file of 79 868 nursing home-week observations from 10 872 unique facilities. We found that a positive profit margin was associated with a 21.0% lower probability of reporting PPE shortages in chain-affiliated nursing homes, but not in non-chain nursing homes. Having adequate financial resources may help nursing homes address future emergencies, especially those affiliated with a multi-facility chain.

The COVID-19 – related problems encountered by nursing homes in Poland and the steps undertaken to prevent disease spread in the first phase of the epidemic

Nursing Homes (NHs) are institutions of social assistance run by local governments or non-government organizations. Their purpose is to provide individuals with basic services. On March 20, 2020, the Regulation of the Minister of Health issued the declaration of the COVID-19 epidemic in Poland. The introduction of legal regulations allowed the authorities to take actions to prevent infections at NHs. The aim of the study was to analyze the COVID-19 – related problems encountered by nursing homes in Poland and the steps undertaken to prevent disease spread in the first phase of the epidemic.

The survey was conducted with use of an original questionnaire e-mailed to 532 NHs throughout Poland in May 2020. Results were analysed by way of the IBM SPSS Statistics program.

A total of 89 completed questionnaires were received from: 40 NHs organized by local government (44.9%), 24 run by churches (27.0%), 13 established by non-governmental organizations (14.6%) and 12 operating privately (13.5%). Among them, 78 NHs had less than 100 employees (87.6%) and 11 had more than 100 employees (12.4%), while 68 had up to 100 inhabitants (76.4%) and 21 had more than 100 inhabitants (23.6%). All NHs had problems with recruiting and retaining enough nursing staff.

The most commonly used method of COVID-19 spread prevention at NHs in the first phase of the pandemic was establishing an increased sanitary regime, monitoring of temperature of residents and staff members and preparing isolation rooms. The greatest problem was personnel shortages.

The principal-agent problem and owner-managers: An instrumental variables application to nursing home quality

The literature on provider ownership has primarily focused broadly on for-profits compared with nonprofits and chains versus nonchains. However, the understanding of more nuanced ownership arrangements within individual facilities is limited. Utilizing the principal-agent and managerial control frameworks, we study the role of managerial ownership and its relationship to quality among for-profit nursing homes (NHs). We identify NH administrators with more than 5% ownership (owner-manager) from Ohio Medicaid Cost Reports (2005-2010) and link these data to long-stay resident records in the Minimum Data Set. Using differential distance to the nearest NHs with a salaried manager relative to an owner-manager, we address the differential selection into these two types of NHs. After instrumenting for admissions to owner-managed NHs, quality among long-stay residents at owner-managed NHs is generally better than NHs with salaried managers. We find suggestive evidence that the magnitudes of quality difference are larger when the principal-agent problem is likely more pronounced, such as when NHs that are part of a multifacility chain and located in more concentrated markets.