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Five largest for-profit nursing home chains in Canada in 2015-2016. 

Five largest for-profit nursing home chains in Canada in 2015-2016. 

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This article presents cross-country comparisons of trends in for-profit nursing home chains in Canada, Norway, Sweden, United Kingdom, and the United States. Using public and private industry reports, the study describes ownership, corporate strategies, costs, and quality of the 5 largest for-profit chains in each country. The findings show that la...

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... In a comparative analysis of long-term care marketization in five countries, 92 researchers found more problems with accountability and transparency. The largest for-profit chains are not publicly traded, ...
... As the context of the pandemic in relation to pharmaceuticals is a volatile one, in this paper, we utilise a descriptive case study approach (Yin, 2014;Harrington et al., 2017;Loyd et al., 2014;Nataraja and Peterson, 2019). We take three firms -Johnson and Johnson (J&J), GlaxoSmithKline (GSK) and Novartis to present an ADO (Antecedent-Decisions-Outcomes) understanding based on the descriptive insights of the sudden decisions taken by firms and IMR the outcomes thereafter owing to the antecedentthat is the pandemic in terms of Transaction-Cost Analysis theory's uncertainty facet. ...
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Purpose-This paper aims to determine new-normal uncertainty considerations stemming from the COVID-19 pandemic to consider within transaction-cost analysis for pharmaceuticals. It also aims to propose new-normal market entry strategies to address the uncertainty as a result of COVID-19's implications and provide for lack of knowledge and information in an uncertain business environment by way of Internet of Things (IoT) ecosystem for pharmaceutical market entry. Design/methodology/approach-In this paper, we focus on the uncertainty facet within transaction-cost analysis consideration and utilise a descriptive three-case study approach taking in Johnson and Johnson (J&J), GlaxoSmithKline (GSK) and Novartis to present an ADO (Antecedent-Decisions-Outcomes) understanding of their usual market entry approach, the approach undertaken during the pandemic and the outcomes thereafter facilitating new-normal uncertainty considerations to factor in. Further with this insight, we develop a conceptual framework addressing the transaction-cost analysis implications of uncertainties toward lack of knowledge and information for a new-normal market entry approach and operating strategy for pharmaceuticals applicable due to IoT (Internet of Things). Findings-Uncertainty (external and internal) is different now in the new-normal business environment for pharmaceuticals and boils down to acute shortage of knowledge and information impact to make an appropriately informed decision. Therefore, considering the changed factors to consider, pharmaceuticals need to be able to undertake market entry with vaccines and medicines by way of IoT thereby enabling, the filling of the gap via real-time data access and sharing, including enhancing predictive analysis for sustenance.
... From 2014 to 2019, 80 NHs were sold, representing approximately 23% of Minnesota NHs that were in continuous operation over the period. These rapid changes in ownership were driven, at least in part, by national trends in the NH industry of increased ownership of NHs by private equity firms and the separation of physical plant ownership and operation through the vehicle of real estate investment trusts (Geyman, 2021;Harrington et al., 2017). In addition to being likely to engage in CHOWs, large for-profit NH chains and those owned by private equity firms have had a history of poor care quality and regulatory violations (Braun et al., 2020;Grabowski et al., 2013;Harrington et al., 2012;Hirth et al., 2014). ...
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Background and Objectives Minnesota’s implementation of a new nursing home Value Based Reimbursement (VBR) system in 2016 presented an opportunity to compare the response of nursing homes (NHs) to financial incentives to improve their quality and efficiency. The state substantially increased reimbursement for care-related costs and tied this rate increase to a composite quality score. Coinciding with rate increases of the new VBR system was an increase in ownership changes, with new owners being primarily for-profit entities from outside of Minnesota, including several private equity firms. Our objective was to examine NHs that underwent a change in ownership to determine their cost and quality response to the change. Research Design and Methods Our sample consists of 342 Minnesota NHs that submitted Medicaid cost reports each year from 2013-2019. A time differential two way fixed effects difference-in-difference model is used to assess changes in quality metrics by comparing measures in years prior to and years following the sale for NHs that changed ownership vs. NHs with consistent ownership. Nursing home characteristics, revenue, and spending patterns are examined to understand differences in performance. Results Those NHs with ownership change experienced a decline in quality scores with notable changes to expenditure patterns. They performed worse on Minnesota Department of Health inspection scores and had non-significant declines in measures of quality of life and clinical care. They had declining staff dental and medical benefits and occupancy rates, greater revenue growth from Medicare Part B, and larger increases in administrative management fees. Discussion and Implications Minnesota like many other states has given wide latitude for nursing home ownership changes, without specific oversight for the quality of care and expenditure patterns of new owners. Recommendations include strict guidelines for the transparency of ownership structures, quality performance targets, rigorous financial auditing, and enhanced regulatory oversight.
... Private equity firms now own several of the largest care home chains in the UK, USA, Sweden, and Norway, among other places. 15 Widespread use of predatory financial practices by these entities has sparked concerns about the implications of financialisation for quality of care, working conditions, and economic and operational stability across the sector. 16 In this Personal View, we explore whether the neoliberal market principles of competition, consumer choice, and profit-which have been used to guide commissioning and provisioning decisions for the past 30 years-are fit for purpose. ...
... 43 Sweden Nursing homes (2014): 18-19% for-profit, 2-3% non-profit, 79% government. 15 Individuals are free to choose between all authorised providers who meet the necessary requirements. 44 Authorised providers compete for individual customers. ...
... For example, in the UK 86% of care homes are operated by for-profit companies, whereas in Sweden just 18-19% are. 15 Competition for individual customers is still present in Sweden, but profit is not a factor for the majority of providers. The effect of this dynamic is also likely to depend on the extent to which governments exercise their market power to cap prices-something that has been reported as an ongoing issue in countries such as Australia, 43 the UK, 54 and the USA, 55 where the budgets of local government appear to play the most significant role in determining care sector spending, rather than the true cost of providing care. ...
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... In many parts of the Western world an increasing percentage of older adults with declining health are offered care at home [1][2][3][4][5]. A reason for this is the growing population aged 65 years and above, so that in several Western countries the number of nursing home beds per 1000 population has declined in recent years [3]. ...
... In many parts of the Western world an increasing percentage of older adults with declining health are offered care at home [1][2][3][4][5]. A reason for this is the growing population aged 65 years and above, so that in several Western countries the number of nursing home beds per 1000 population has declined in recent years [3]. In addition to the fact that people live longer, developments in society have been to create possibilities for older adults to live at home for as long as possible. ...
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Background Home care recipients have reported little self-determination and opportunity to influence their own care. Person-centred care focusing on involvement has improved the quality of life of older adults in health care and nursing homes; however, knowledge about the effects of person-centred interventions in aged care at home is sparse. The aim of this study was to study the effects of a person-centred and health-promoting intervention, compared with usual care, on health-related quality of life, thriving and self-determination among older adults, and on job satisfaction, stress of conscience and level of person-centred care among care staff. Methods This is a non-randomized controlled trial with a before/after design. Participants from five home care districts in one municipality in northern Sweden were recruited to an intervention or control group. We evaluated health-related quality of life, thriving and self-determination among older home care recipients, and job satisfaction, person-centred care and stress of conscience among care staff. Evaluation was performed by questionnaires and responses were analysed using parametric and non-parametric statistical analyses. Results Eighty-one older adults and 48 staff were included in the study. A clinically moderate and statistically significant difference between the intervention and control groups was found in thriving and negative emotions among older adults. The intervention contributed to maintaining high thriving levels, in contrast to decreased thriving in the control group (intervention: + 1, control: − 4, p 0.026, CI: − 10. 766, − 0.717). However, the intervention group rated an increase in negative emotions, while the control group was unchanged (intervention: − 7 control: + − 0, p 0.048, CI: − 17.435, − 0.098). No significant effects were found among staff. Conclusions The intervention contributed to maintaining high levels of thriving in contrast to low levels found in the control group, and it seems reasonable to consider the intervention focus on staff as more person-centred and health-promoting. The finding that the intervention group had increase in negative emotions is difficult to interpret, and warrants further exploration. Even though the results are sparse, the challenges discussed may be of importance for future studies in the context of HCS. Trial registration NCT02846246. Date of registration: 27 July 2016.
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Social care markets often rely on the for-profit sector to meet service demand. For-profit care homes have been reported to suffer higher rates of coronavirus disease 2019 (COVID-19) infections and deaths, but it is unclear whether these worse outcomes can be attributed to ownership status. To address this, we designed and prospectively registered a living systematic review protocol (CRD42020218673). Here we report on the systematic review and quality appraisal of 32 studies across five countries that investigated ownership variation in COVID-19 outcomes among care homes. We show that, although for-profit ownership was not consistently associated with a higher risk of a COVID-19 outbreak, there was evidence that for-profit care homes had higher rates of COVID-19 infections and deaths. We also found evidence that for-profit ownership was associated with personal protective equipment (PPE) shortages. Variation in COVID-19 outcomes is not driven by ownership status alone, and factors related to staffing, provider size and resident characteristics were also linked to poorer outcomes. However, this synthesis finds that for-profit status and care home characteristics associated with for-profit status are linked to exacerbated COVID-19 outcomes.
... Furthermore, the extension of LTC policies was often closely interlinked with the "marketization of care" (Bode 2008;Brennan et al. 2012;Harrington et al. 2017). The marketization refers to a stronger provider competition as welfare states also promoted private, for-profit care providers (Brennan et al. 2012;Meagher & Szebehely 2013;Gilbert 2015). ...
... Since the 1990s, many welfare states in Europe have introduced or expanded marketization of LTC policies in order to improve efficiency of care provision and/or to contain public LTC expenditure (Gingrich 2011;Klenk & Pavolini 2015;Deusdad et al. 2016a;Harrington et al. 2017). Comparative welfare state research mainly deals with two key forms of marketization: a) privatization and increasing competition among care providers and b) the strengthening of the consumer role of care recipients. ...
... In the late 1990s, ideas of marketization have started to influence the development of LTC policy in Norway and promoted privatization, "consumer choice" and new public management (Harrington et al. 2017;Vabo et al. 2013). In principle, private providers (non-and for-profit) are allowed to supply services based on contracts with municipalities according to the same quality criteria and prices as public LTC providers. ...
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Against the background of demographic ageing and increasing female labour market participation, many European welfare states restructured their long-term care (LTC) policies for persons of age and persons with disabilities by strengthening social rights to receive publicly funded care and extending care infrastructure since the 1990s. Despite this trend, care by family members remains a relevant factor in care provision. However, most European welfare states introduced forms of pay and social security rights for care-giving family members in the meantime and thereby transformed the previously informal character of family care provision. The aim of this report is to examine European LTC policies in a historical and international comparative perspective. It identifies existing institutional constellations in LTC to highlight salient policy differences and assess the policies in terms of current demographic and epidemiological trends. The study is based on the analysis of care policies legislation and political documents, standardized EUROSHIP country reports, data from comparative European policy databases as well as secondary literature. It compares welfare states of Norway, Germany, Spain, Italy, the United Kingdom, Estonia, and Hungary, representing different European regions and welfare state traditions. The report introduces an innovative multi-dimensional approach to the measurement of policy generosity and develops a new typology of LTC policies based on the relationship between the generosity of different policy instruments supporting extra-familial and paid familial care. It also examines how far LTC policies potentially affect poverty risks, gender inequality and unmet needs as well as options for choice. Furthermore, historical trends in LTC policy development are discussed in order to analyze historical changes and path dependencies in the investments in publicly financed LTC and social regulation of providers of LTC services. Finally, it is explored in how far European welfare states differ with regard to their social resilience in the context of current demographic and epidemiological trends in Europe, especially population ageing and the increase in prevalence of multi-morbidity and higher levels of disability.
... In Sweden, large international corporations increasingly dominate the eldercare services market (Harrington et al. 2017). Of all nursing home care in Sweden, 12 934 permanent and temporary beds (13.5% of all beds) were provided by the five largest chains in 2015. ...
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This study focuses on financing for long-term care (LTC). LTC involves a range of services including medical and nursing care, personal care services, assistance services and social services that help people live independently or in residential settings when they can no longer carry out routine activities on their own. Governments should invest in LTC to provide access to care that older persons need, ensure financial protection against high out-of-pocket spending, and provide a social safety net for those unable to pay for required services. The objectives of this study are to describe experiences in financing and price setting and how pricing has been used to attain better coverage, quality, financial protection, and outcomes in LTC. Pricing is an important policy tool that provides the right incentives to ensure that budgetary goals are met, to promote quality, to increase equity, and to foster coordination and integration with health services. Case studies were carried out in Australia, France, Germany, Japan, the Republic of Korea, the Netherlands, Spain, Sweden, and the United States of America (USA) to examine the organization, financing and price setting for LTC services, and to review experiences in the use of pricing to achieve policy objectives.
... In recent decades, various countries have introduced market-based principles to control growing long-term care (LTC) expenditures (Harrington et al., 2017;Meagher & Szebehely, 2013); this in itself is underpinned in the neoliberal and New Public Management paradigms (Maarse, 2006). These paradigms promote values such as individualism, free market principles and austerity via privatisation, and decentralisation (McGregor, 2001). ...
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Context: Some nursing homes fared better than others to protect themselves against the 2019 coronavirus disease (COVID-19). Organisational characteristics may mediate the effect of the COVID-19 pandemic. Previous reviews have suggested for-profit providers provide worse quality of care. Does ownership also matter in the response to the COVID-19 pandemic?Objective: The aim of this literature review is to evaluate the relationship between ownership structure of nursing homes and their performance during the pandemic, measured as COVID-19 cases and deaths.Method: A rapid literature review was conducted in PubMed and Web of Science, following a systematic approach. The search was conducted in October 2020 and updated in December 2020. Articles were selected based on a pre-defined set of PICOT criteria and underwent risk of bias assessment.Findings: Eighteen papers were included in this rapid review. These papers cover a period from March to July 2020. The majority of papers found a significant relationship in the unadjusted statistics between ownership status and effectiveness in response to the COVID-19 pandemic. However, the adjusted figures paint a more nuanced picture. The relationship seems to be mediated by other organisational (e.g., size), process (e.g., staff shortages) and contextual factors (e.g., regional spread of COVID-19) in comparison to ownership directly.Limitations: The majority of the included studies focus on North America, and most studies are of low to medium quality with respect to research methodology.Implications: In the short-term, it will likely be more effective to address identified mediating factors of the relationship between ownership and COVID-19 outcomes; but for the long-term, this review is in keeping with previous literature suggesting policymakers should be cautious about encouraging the ownership of nursing homes by for-profit providers.
... Attention has also been given to for-profit providers, for instance comparisons of the biggest chains in long-term care in countries such as Canada, Norway, Sweden and the US (Harrington et al. 2017). Studies has also been performed on the growth of for-profit providers in the sector of residential care for children and youths in Sweden (Meagher et al. 2016). ...
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This article aims to analyse the position of the public provider (i.e. share of recipients) of home-care services in Swedish municipalities with marketization: a system of choice. Following the literature, an assumption is that the public provider has difficulties in surviving the competition with private home-care providers. In addition, the relevancy of this assumption could differ between different municipal settings. To test this assumption, we use statistical analysis. The main result is that the public provider is a ‘strong player’ in most municipalities experiencing marketization. However, there exists a variation in this respect – the position varies between municipalities.