Ownership change in American nursing homes during the COVID-19 pandemic and the relationship with measures in Donabedian's model of care quality.

BACKGROUND AND

OBJECTIVES

Concerns exist about the implications of ownership change on nursing home performance. The objective of this study was to examine relationships between facility and resident characteristics to ownership change in American nursing homes during the COVID-19 pandemic.

RESEARCH DESIGN AND

METHODS

A retrospective cohort of nursing homes was obtained from the Centers for Medicare and Medicaid Care Compare open datasets in the United States, to assess the incidence proportion of ownership change, and conversion during the COVID-19 pandemic. Linkage was made at the facility-level of nursing home at seven semi-annual cross-sectional survey cycles between March 2020 to March 2023. Structural equation modeling examined relationships between ownership change and variables comprising domains in Donabedian's structure-process-outcome model for care quality.

RESULTS

Of the 9,256 for-profit nursing homes with an organization owner that completed two or more semi-annual surveys, 62.8% had an ownership change. Among government (n = 745) and non-profit (n = 2,555) nursing homes with an organization owner, the incidence proportion of ownership change was 48.6% and 42.7%, respectively. Approximately 22.7% of government nursing homes converted to for-profit ownership. Predominant ownership type of facility at baseline modified the association between ownership change and total weighted health inspection score, occupancy ratio, resident seasonal influenza and SARS-CoV-2 vaccination, and the prevalence of long-stay residents having pressure ulcers.

DISCUSSION AND IMPLICATIONS: Ownership change was prevalent throughout the COVID-19 pandemic period. Factors associated with a change in ownership were related to several care quality metrics, suggesting that ownership change was driven by poorer care quality.