Preprint: The Relationship between Ownership of Nursing Homes and their Response to the COVID-19 Pandemic: a Systematic Review

Please note that this article is currently under review with a journal and may be subject to change

Florien M. Kruse*1, Jasmine Mah2, Sanne Metsemakers1, Melissa K. Andrew3 & Patrick P.T. Jeurissen1,4

1 IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands, 2 Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada, 3 Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada 4 Ministry of Health, Welfare and Sport, The Hague, the Netherlands


Introduction: The nursing home sector has been disproportionally affected by the 2019 coronavirus disease (COVID-19) and pandemic. Nursing home residents are particularly vulnerable to the virus, resulting in a high number of outbreaks and deaths. However, some nursing homes fared better than others; organisational characteristics to some extent may mediate the effect of the COVID-19 pandemic. The aim of this literature review is to evaluate the relationship between ownership structure of nursing homes and their performance during the COVID-19 crisis.

Methods: A rapid literature review was conducted in PubMed and Web of Science. This literature review followed a systematic approach including a risk of bias assessment. Articles were selected based on a pre-defined set of PICOT criteria that included studies which compared for-profit nursing homes to non-profit and public nursing homes with regard to the effectiveness in response to the COVID-19 pandemic, measured in terms of number of COVID-19 cases and deaths.  

Results: In total, eighteen papers were included in this systematic review. The majority of papers found a significant relationship in the unadjusted statistics between ownership status and effectiveness in response to the COVID-19 pandemic. However, the adjusted figures paint a more nuanced picture. The relationship seems to be mediated by other organisational (e.g. size), process (e.g. access to personal protective equipment) and contextual factors (e.g. regional spread of COVID-19).

Conclusion: Ownership matters, but mainly because of the underlying organisational, process and contextual factors. The policy implications of these findings are timely: policymakers can either disincentivise for-profit entities (or favour non-profit providers), or improve the regulation of underlying factors that relate to COVID-19 outcomes. Even as discussions are undertaken about the values that underlie the future of nursing home ownership, steps can be taken now within existing ownership structures to address the factors most closely associated with outcomes. In the short-term it is better to address these mediating factors, but for the long-term, this review is in keeping with previous literature suggesting policymakers should be wary of for-profit nursing homes.  

The full paper is available here:

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