Abstract
Margaret McGregor and colleagues consider Bradford Hill's framework for examining causation in observational research for the association between nursing home care quality and for-profit ownership.
Highlights
Nursing homes, called residential long-term care facilities or aged care homes, are regulated institutions providing around-the-clock medical and social care to older people who are unable to live independently due to physical and/or mental disability
Nursing home residents are a highly vulnerable population, and nursing home care quality has been a persistent focus of public concern
There is considerable evidence from observational studies that public funding of care delivered in for-profit facilities is inferior to care delivered in public or nonprofit facilities
Summary
Nursing home residents are a highly vulnerable population, and nursing home care quality has been a persistent focus of public concern. There is considerable evidence from observational studies that public funding of care delivered in for-profit facilities is inferior to care delivered in public or nonprofit facilities. The past decade has seen many industrialized countries increasing governmental payment for care of frail seniors in for-profit nursing homes, leading to questions about whether this leads to inferior care. Many of Bradford Hill’s guidelines for causation can be found in published studies supporting a causal link between for-profit ownership and inferior care. The precautionary principle should be applied when developing policy for this frail and vulnerable population. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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