For Profit. Not-for-Profit. What’s the Difference?

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Quick question: You’re choosing a nursing home for someone you love. Do you pick an independent non-profit facility, or a large for-profit chain?

What you choose can make a big difference.

Studies show not-for-profit nursing homes offer higher quality of care. An analysis of 82 studies comparing quality of care in for-profit and not-for-profit nursing facilities reported that nearly all the studies found higher quality, higher staffing, and fewer pressure sores in not-for-profit facilities.

The thorough review involved thousands of U.S. nursing homes and compared quality-of-care measurements in 82 individual studies that collected data from 1965 to 2003.

“The results are unequivocal and completely consistent with other studies comparing for-profit versus nonprofit care,” said Dr. Gordon Guyatt, author of the study, and a leader in evidence-based medicine.

This is good news for not-for-profit facilities such as Columbia Basin Care in The Dalles, but bad news for people living in areas with limited choices in facilities. In the U.S., nearly all nursing homes — 70 percent — are for-profit facilities, according to the Center for Disease Control.

In Oregon that number is even higher: 80 percent of nursing homes operate as for-profit facilities, with just 17 percent operating as not-for-profits, and 3 percent government-owned.

At the same time, Oregon’s elderly population is growing rapidly. By 2030, the number of people over age 85 — the age group most likely to need long-term care services — is expected to grow 66 percent.

Columbia Basin Care, located in The Dalles, is the region’s only community-owned, not-for-profit skilled nursing facility. Founded in 1964, Columbia Basin Care has served the community for over 50 years and employs over 80 people.

The long-term care facility is run by a volunteer Board of Directors, comprised of individuals who live and work in The Dalles. Aidan Health Services, a management company, provides oversight and support. While Wasco County owns the building and grounds, Columbia Basin is an independent compa­ny with local control and decision-making authority. As a non-profit, there are no owners or investors, and funds are dedicated to facility upgrades and staff improvements to increase quality of life for residents.

“This is our community, our neighbors, and our families,” says Valerie Hiveley-Blatz, a geriatric nurse practitioner who serves as primary care provider for residents at Columbia Basin Care. “We get to know and care for every resident on an individual level. Our office is here, so we are able to respond to any need quickly. And every person here, from nurses to aides to the kitchen and housekeeping crew, wants what’s best for the residents.”

Most experts agree that a quality facility is based on staffing levels, and note that for-profit facilities — and particularly large corporate chains — often cut corners to save money and boost profits.

Nurses working in nonprofit nursing homes were significantly more satisfied with their jobs, according to a study of 900 registered nurses working in 300 skilled nursing facilities. A similar study show certified nursing assistants were more satisfied and preferred working in non-profit facilities.

“The for-profits don’t have enough staff,” said Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy. Non-profits, he says, “staff at a higher level, and that’s why their care is generally better.”

Aubree Olmstead, executive director of Columbia Basin Care, acknowledges the gap. “The care and concern for our residents is genuine, and that makes such a difference,” she says.