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Does profit status affect hospitalization and mortality rates in long-term care homes? Bruyère Research Institute study sheds light

September 30, 2015

Today, the Bruyère Research Institute (BRI) announces the findings of a new study which examines the differences in hospitalization and mortality rates of residents newly admitted to Ontario long-term care (LTC) homes (also known as nursing homes).

Published in the Journal of the American Medical Directors Association, the research project included 53,739 residents over a three-year period, from 2010 to 2012. Overall, the results indicate that for-profit facilities have significantly higher hospitalization and mortality rates than not-for-profit facilities. The study uses data housed at the Institute for Clinical Evaluative Sciences.

Six months following admission, and following adjustment for multiple factors at the individual and facility level, the mortality rate in for-profit homes was 16 per cent higher, and the hospitalization rate was 33 per cent higher in for-profit homes, than in not-for-profit homes. During this period, residents in for-profit facilities had an unadjusted hospitalization rate of 565 per 1,000 Person Years (PY) of follow-up versus 416 per 1,000 PY in not-for-profit facilities. The corresponding crude mortality rate in for-profit facilities was 252 per 1,000 PY versus 216 per 1,000 PY in not-for-profit facilities.

“Our results take advantage of a natural experiment in Ontario, where the funding level and the characteristics of residents in for-profit and not-for-profit homes are similar,” says Dr. Peter Tanuseputro, research project lead at BRI and The Ottawa Hospital. “The fact that the resident wait-list and placement system is also standardized helps maintain this similarity.”

Of Ontario’s 640 long-term care homes, 384 (or 60 per cent) are for-profit facilities. However, regardless of their profit status, all nursing homes receive standardized government funding for each patient, which is set by a formal assessment of each resident’s care needs.

“A facility’s profit status is only one of many factors that affect hospitalization and mortality rates,” states Dr. Tanuseputro. “Some for-profit facilities are in the top 20 per cent of facilities that had the lowest rates of hospitalization or mortality. Conversely, some not-for-profit facilities were in the bottom 20 per cent. Other factors such as the size and location of a facility are also important contributors.”

Previous literature suggested that differences in resident outcomes may also depend on staffing levels, ease of access to specialized medical services and additional sources of generated income such as donations.

An accompanying online calculator uses the study findings to predict the chance that a long-term care resident will die in the six months after admission: www.projectbiglife.ca/elderly. It considers information such as a person’s socio-demographics (e.g., age, sex and marital status), a person’s health and the characteristics of the nursing home. This calculator can be used by residents, their family members and/or caregivers to inform care planning.

About the Bruyère Research Institute
The Bruyère Research Institute is a bilingual not-for-profit organization which partners with Bruyère and the University of Ottawa to support researchers who contribute to relevant and practical knowledge through programs of health research and programming related to primary and community care, equity, cognition and mobility, health systems and services, and promising practices.

About The Ottawa Hospital
The Ottawa Hospital is one of Canada’s largest learning and research hospitals with over 1,100 beds, approximately 12,000 staff and an annual budget of over $1.2 billion. Our focus on research and learning helps us develop new and innovative ways to treat patients and improve care. As a multi-campus hospital, affiliated with the University of Ottawa, we deliver specialized care to the Eastern Ontario region, but our techniques and research discoveries are adopted around the world. We engage the community at all levels to support our vision for better patient care.

For further information, please contact


Jennifer Ganton
Director, Communications and Public Relations,
Ottawa Hospital Research Institute
Office: 613-798-5555 x 73325
Cell:613-614-5253
jganton@ohri.ca