Ownership Model or Chain Affiliation

Does ownership model or chain affiliation matter in residential aged care?

December 13 2018

Rosemary Frey discusses her latest paper published earlier this month

Large for-profit residential aged care (RAC) chains are increasingly becoming dominant players in the long-term care market in New Zealand. However, the marketization of RAC poses new challenges to the New Zealand government healthcare policy.  The big question is – what model supports optimum care delivery?

Together with Te Ārai colleagues, I’ve just published a new study that helps answer this question. The study, from the School of Nursing University of Auckland and published in the Journal of Pain and Symptom Management, analysed after-death questionnaire data from 217 resident deaths in 51 hospital-level facilities (the highest level of need). The results form part of Michal Boyd’s End of Life Dementia Experience Research (ELDER) project, a study examining the nature of dying with neurodegenerative diseases in residential aged care facilities across New Zealand.

Overall, we found that large not-for-profit RAC facilities provide better resident end-of-life comfort and symptom management than small for-profit facilities. Study results are in line with extensive research findings that for-profit RACS record worse resident quality of care. Curiously in contrast to the prevailing body of literature, results of the study also indicated that chain membership was not in and of itself indicative of poor quality care. Residents of chain not-for-profit facilities recorded greater comfort during the last week of life than did residents of stand-alone for-profit facilities.  We speculate that the economies of scale provided by chain affiliation may have afforded better care. However, we would caution that further studies are also needed to clearly explain which aspects of ownership and corporate structure have the greatest impact on resident quality of care.

Nationally, about three quarters of RAC facilities in New Zealand are for profit.  Uur study results indicate an urgent need for the New Zealand government to develop policy in line with the evolving trends in ownership, including requirements for financial accountability, quality reporting, oversight, and enforcement.  In the meantime, families need more and better information to navigate this changing landscape in selecting the best care for their loved ones.  Please see our easy to read flyer on how to choose a residential aged care facility.