Care deficiencies and super-organization of American nursing homes in hospital referral region: an ecological cohort study

Abstract Background Super-organization has been associated with worse care quality in nursing homes. Previous research on the chain ownership of American nursing homes excluded government facilities in public-private partnerships, and focused on corporate entities. This longitudinal study proposes a novel method of demarcating the latent ownership networks of for-profit, government and non-profit nursing homes in hospital referral region. Methods Facility characteristics and care quality measures were analyzed from an ecological cohort of 9,001 American nursing homes that had a registered organization for owner and were reimbursed through Medicare and Medicaid. Information was obtained from the Nursing Home Compare open datasets at five semi-annual processing dates from March 2016 to March 2018. Ownership networks of American nursing homes were constructed through application of social network analysis, using the exact legal name of registered organizations. As hospital discharge is a routine admission source of nursing home residents, hospital referral region was actualized to demarcate focal area. Utilizing Bayesian hierarchical models, the association between nursing home super-organization in hospital referral region (inferred by degree-based centrality and Herfindahl-Hirschman Index) to scope of cited care deficiencies (denoted by Total Weighted Health Survey Score) was explored. Results The percentage of nursing homes having super-organization increased from 56.8–56.9% over the two-year period. During this interval, the mean size of nursing home ownership group in hospital referral region increased from 3.11 to 3.23 facilities. Conclusions Overall, super-organization in hospital referral region was not associated with care deficiencies in American nursing homes. However, among nursing home with super-organization, being part of an ownership group with more facilities was beneficial for care quality. Evidence suggests that super-organization is detrimental for government nursing homes.