The Fight Against the Privatization of Nursing Homes

Authored By: Carla Hu

Imagine for a moment where you might be living at the age of 65 or older. For many Americans, that answer may be a senior assisted living community, also known as a nursing home. In 2017, a CDC survey showed the U.S. has 1.3 million nursing home residents [1]. Furthermore, recent surveys reveal that from 2000 to 2020, among the 15,300 nursing homes in the U.S., the proportion of for-profit nursing homes increased from 65% to over 70% [2, 3]. Nursing homes are a significant form of long-term healthcare in the U.S., however debates surrounding their quality of care and facility ownership are often overlooked by the general public. 

The number of nursing homes has been declining, while the number of older adults in need of long term care continues to rise. From 2015 to 2024, the number of nursing homes decreased by 5%, while the number of senior citizens increased from 46.2 million to 58 million people [4, 5]. Furthermore, there has been an increase in the average number of deficiencies per nursing home [4]. These statistics were likely influenced by the COVID-19 pandemic, as many older adults chose at-home care or community-based living over nursing homes[4]. However, as nursing home populations rebound following the pandemic, staff shortages and concerns about quality of care have become more apparent[4]. Many older adults rely on nursing homes for long-term care, therefore making it crucial to address the ongoing deficits in care that have come to light.

Nursing homes face a significant challenge with ownership and its impact on patient care standards. In rural communities in Wisconsin, older adults and their families are protesting against the increased privatization of nursing homes [6]. They are leading town halls and utilizing call centers to support political candidates who promise to protect public nursing homes from being bought by healthcare companies who have a record of fines and deficiencies in care [6]. According to Weill Cornell Medicine’s Population Health Sciences Department, about 5 percent of nursing homes in the United States are currently owned by private equity firms, which often provide a lower quality of care [7]. Theseprivately owned nursing homes often lack transparency regarding their ownership, which limits accountability when quality issues arise [8]. Furthermore, patients in private nursing homes often spend more through Medicare to receive the same quality of care as public nursing homes [8]. Additionally, private nursing homes are notorious for not reporting suspected abuse in a timely manner, restricting food and fluids available to residents, and preventing them from voicing their grievances due to fear of retaliation [6].

Because many older adults depend on nursing homes, changes need to be made to prevent their mismanagement. According to the NIH, public non-profit nursing homes provide higher-quality care, as shown by fewer physical restraint used and less deficiencies in governmental regulatory assessments [9]. Therefore, regulatory changes to increase accountability could include policies to improve transparency by mandating the ownership of nursing homes to be publicly disclosed [6]. Furthermore, focusing on creating open dialogue with residents in privately-owned nursing homes can prevent inadequacies in care from occurring when unpredictable cost-cutting measures may compromise care and staffing stability  [6, 7]. Therefore, it is imperative for us to understand key problems faced in many privately-owned nursing homes and encourage residents' advocacy to improve conditions.

Older adults in private-owned nursing homes face significant challenges due to receiving insufficient care and having a limited voice in decisions that affect their well-being. These inadequacies have pushed older adults to protest, such as the situation in Wisconsin, reflecting how residents are willing to take a hands-on approach to legislative reform. As students, we must examine how nursing homes are being managed and advocate for improvements in elder care to guarantee safe living conditions for current and future generations.

References

1. Sengupta M, Lendon JP, Caffrey C, Melekin A, Singh P. (2022) Post-acute and long-term care providers and services users in the United States, 2017–2018. National Center for Health Statistics. Vital Health Stat 3(47). https://dx.doi.org/10.15620/cdc:115346.

2. Centers for Disease Control and Prevention. (2019) “FastStats - Nursing Home Care.” National Center for Health Statistics, www.cdc.gov/nchs/fastats/nursing-home-care.htm.

3. Kardashian, Kirk. (2021). “Does the Profit Motive Make Nursing Homes Better or Worse?” Tuck Dartmouth. www.tuck.dartmouth.edu/news/articles/does-profit-motive-make-nursing-homes-better-or-worse.

4. Chidambaram, Priya, and Alice Burns (2024). “A Look at Nursing Facility Characteristics between 2015 and 2023.” KFF. www.kff.org/medicaid/issue-brief/a-look-at-nursing-facility-characteristics/.

5. Mather, Mark, and Paola Scommegna. (2024) “Fact Sheet: Aging in the United States.” Population Reference Bureau. www.prb.org/resources/fact-sheet-aging-in-the-united-states/.

6. Goehl, George. (2024) “Not in Our Nursing Homes.” In These Times. inthesetimes.com/article/wisconsin-seniors-nursing-home-healthcare-rural-privatization-organizing.

7. “Private Equity Ownership of Nursing Homes Linked to Lower Quality of Care, Higher Medicare Costs.” (2021) WCM Newsroom, Weill Cornell Medicine, news.weill.cornell.edu/news/2021/11/private-equity-ownership-of-nursing-homes-linked-to-lower-quality-of-care-higher. 

8. Rafiei, Yasmin. (2022) “When Private Equity Takes over a Nursing Home.” The New Yorker, www.newyorker.com/news/dispatch/when-private-equity-takes-over-a-nursing-home.

9. Comondore, V. R., Devereaux, P. J., Zhou, Q., Stone, S. B., Busse, J. W., Ravindran, N. C., Burns, K. E., Haines, T., Stringer, B., Cook, D. J., Walter, S. D., Sullivan, T., Berwanger, O., Bhandari, M., Banglawala, S., Lavis, J. N., Petrisor, B., Schünemann, H., Walsh, K., Bhatnagar, N., … Guyatt, G. H. (2009). Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis. BMJ (Clinical research ed.), 339, b2732. https://doi.org/10.1136/bmj.b2732