If you're considering a nursing home, beware. Check out staff-to-patient ratio and learn who owns the place.

That's a lesson from a new report by researchers at UC San Francisco, who aimed to compare quality of care in the country's 10 largest for-profit nursing home chains with care in other for-profits, nonprofits and government-run facilities.

Their findings: Staffing levels were lower and deficiencies in care were higher, in the for-profits -- both at the largest chains and at the smaller for-profit facilities -- than the nonprofits, and chains purchased by private equity companies showed more deficiencies after the purchase than before.

"Poor quality of care is endemic in many nursing homes, but we found that the most serious problems occur in the largest for-profit homes," said first author Charlene Harrington, professor emeritus of sociology and nursing at UCSF, in a statement.

Many of these 10 chains have facilities in California, according to Pat McGinnis, executive director of California Advocates for Nursing Home Reform.

According to the study, the 10 largest for-profit chains in the United States operate around 2,000 nursing homes, controlling around 13 percent of nursing home beds. Of these facilities, nearly 1,000 were bought by private equity companies between 2003-2007.

The study covered 2003-2008.


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Researchers found that total nursing hours were lower in the top 10 nursing home chains than all other groups, while the number of "deficiencies" and "serious deficiencies" were "significantly higher" in the top 10 chains than any other group. Deficiencies include failure to prevent pressure sores, resident weight loss, falls, infections, resident mistreatment, poor sanitary conditions and similar problems.

A friend landed in one of these big-chain places in another state after Medicare stopped payment for his hospitalization. From intensive care with round-the-clock treatment, he was placed in a shared room where he rarely saw a registered nurse. The only doctor on staff, the "medical director," was on vacation when he arrived, and no physician attended him for several days. His condition worsened, but no staff member apparently noticed. After a crisis, my friend was rushed into an ambulance and returned to the hospital and intensive care.

Low staffing levels are a concern, the study said, because they are associated with poor "resident outcomes." However, such low levels mean low labor costs, which, the study said, "appear to be a management strategy to reduce costs."

It's about money, said McGinnis. "You cannot provide decent care in a for-profit system."

But, the study said the new healthcare bill, the Affordable Care Act, aims to make information more available in two important areas. Facilities are required to report staffing data, so staff ratio can be checked. And transparency of ownership will be required.

"Currently, nobody take responsibility, nobody is held accountable for problems," said Tippy Irwin, executive director of Ombudsman Services of San Mateo County, a nonprofit agency that investigates nursing homes.

Prescott Cole, senior attorney at CANHR, suggests that families looking for a nursing home should: 1. Call the ombudsman program in their county for information and advice; 2. Visit before at different hours of the day to check out staff-to-patient ratio, and "just be there" to see what it's like.

The authors of the study call for more research, especially for chains purchased by private equity firms "because they are under pressure to improve shareholder and investor values, with little oversight by regulators."

You can find the article online and in the print publication "Health Services Research."

Addendum: the 10 largest U.S. for-profit chains are HCR Manor Care, Golden Living, Life Care Centers of America, Kindred Healthcare, Genesis HealthCare Corporation, Sun Health Care Group Inc., SavaSeniorCare LLC, Extendicare Health Services Inc., National Health Care Corp., and Skilled HealthCare, LLC.

For comments or story ideas contact Joan Aragone at joanaragone@gmail.com.