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Changes in nursing home ownership may have a small, but statistically significant, negative impact on staffing levels and the overall quality of patient care at nursing homes, according to new research. 

Investigators from the University of Pennsylvania and the Department of Veterans Affairs Medical Center in Philadelphia conducted a retrospective study of changes in nursing home ownership between 2016-2022 and how they impacted nursing home quality of care. Findings appeared in the Journal of the American Geriatrics Society. 

The researchers used data from the Centers for Medicare & Medicaid Services from 2016-2022 of nearly 3,600 nursing homes that changed ownership to determine if there were noticeable shifts in quality ratings after the properties changed hands. 

“Change could theoretically be good for these nursing homes, but we needed to see the impact of having new owners,” Kira L. Ryskina, the MD, MSHP, the study’s lead author and assistant professor in the Department of General Internal Medicine at the Perelman School of Medicine at UPenn, said in a news release. 

The research team, which was led by Ryskina and Rachel M. Werner, executive director at the Leonard Davis Institute of Health Economics at UPenn, used CMS star ratings to measure the overall quality ratings of the facility and individual components, which include health inspections, clinical measures (such as bedsores, catheter use, restraints) and staffing levels. 

They found a slight decrease in the overall quality ratings of nearly 0.1 point on the 5-star scale, which was primarily driven by a 0.2 point decline in staffing ratings, as well as a 0.07 point decrease in health inspection ratings. The overall decline in facility ratings was offset somewhat by a 0.15 point increase in certain quality measures, the researchers found. 

“Overall, we observed a negative, albeit small impact of change of ownership on the 5-star quality ratings,” Ryskina said. “Our current work extends the literature about the negative impact of private equity acquisitions on patient outcomes to other types of ownership changes, but also shows the impact on the 5-star ratings is relatively small.”

Some previous UPenn research has shown that nursing home acquisitions by private equity groups are associated with poorer patient outcomes, including increased mortality.

However, still other studies have found changes in nursing home ownership do not necessarily have a negative impact on quality of care. 

In a study published last fall, researchers from the University of Washington looked at Medicare data and other quality measures of more than 11,000 nursing homes in the US between 2016 and 2019. The research team didn’t find an erosion of care in the buildings that changed ownership during their study period. 

Ryskina said the results of the newest study show a need for greater CMS scrutiny and transparency about changes in nursing home leadership, with billions of taxpayer dollars being spent annually on these facilities. 
In recent years, CMS has made an effort to make more nursing home ownership information available to the public to increase transparency in the sector.