Your Granny's Nurse: For-Profit versus Non-Profit Nursing Homes

For-Profits versus Non-Profits

In my twenty three years as a Nursing Home Nurse, I have spent the majority of my time in non-profit facilities, working in one, and traveling to numerous others as an instructor, and occasional student.  Only in the last year have I worked in a for-profit home. I find the differences staggering. Mind you, this is only my opinion.

I suppose I should first explain the difference in the two types of facilities:

A for-profit home is generally owned by a person, or corporation. Generally speaking, the focus is on the bottom line, revenue. For-profits are in the business to make the owners money.I have only worked in one for-profit facility, but know numerous employees of others.

A Non-profit home may also be owned by an individual or corporation, but is more widely known for being owned by a religious organization. A non-profit is in business to provide a service. The coffers of the non-profit must be empty at the end of the fiscal year. All revenue generated within the year must be used within the facility to provide services to those in their care.This may be actualized in providing  additional "perks" and/or services for the residents and increased benefits for employees. Many also have tax exempt status, due to the religious nature of their mission, as was the non-profit where I made my living for twenty one years.  

My personal opinion is that non-profits provide better overall care for their clientele. I admit to a certain prejudice toward the religion based facilities.  Hearing the tales of my colleagues in for-profit homes over the years, and my one year plus in a for-profit facility cements my beliefs.

Compassion is key. Prior to working in a for-profit home, I was under the assumption that all nursing homes were filled with compassionate, caring staff, who put the resident's needs and comfort above all else. I have found this is not the case. I am not saying that homes that turn a profit do not have loving, compassionate care, but it is not foremost, as it is in a non-profit., at least in my experience. 

It seems that the staff in a non-profit has a special calling that is not found in a for-profit. Those without that "special something" are weeded out fairly rapidly. Both administration as well as staff seem more willing to go the extra mile for the patients.

I can remember one instance of a patient being admitted to the home with absolutely no payment source. She had come to Ohio to visit her son, from the Ukraine. She had a stroke, and was rendered dependent on others for her most basic needs. She spoke not a word of English. Her son, whom she came to visit, was an Orthodox Russian priest, who was married, with six young children. He had no way of paying for her care, and she had been denied entrance at numerous homes due to her lack of funds. She could not even apply for Medicaid funding, as she was in the U.S. on a temporary  visa. The Nuns where I worked took her in, gratis. The house physician cared for her, gratis, and the pharmacy supplied her medications, also gratis.

I fully remember complaining that at the time, the staff had been denied their annual cost of living raise, due to lack of funds, but yet the Nuns could afford to take in this woman, who, to be honest, was more than a handful to care for.  Not only did she not speak one word of English, her family was scarce after her admission, and we depended on them for translation. She had Dementia, and we found out, after several months, that she had long standing mental health issues, stemming from a fifteen year stint in a gulag in Siberia as a young woman. She would scream inconsolably every time it stormed. Why, we never learned.  

In retrospect, I realize what a wonderful thing we all had a hand in. That was true Christian charity at work. It was well worth that pittance of a raise, to have cared for this poor soul.

Non-profits tend to have better food. Many for-profits employ "fine dining" programs, and some even employ chefs, but in my  experience, old, sick people are not interested in fancy, nouvelle cuisine. They want only a a couple of things from their food, one, to be recognizable, and two, to taste good. For-profit homes could be much better served by hiring a good COOK, who can master pork chops and apples for one hundred in three consistencies,, than a chef who can create a  masterpiece of salmon encrusted with Mediterranean spices that no one will touch.
When touring a potential home, ask a few residents how they like the food.

Non-profits are better staffed. In Ohio, the mandated patient to nursing assistant ratio is 1:25, which is the ratio that many for-profits use.  Frankly, it may be legal to staff at that ratio, but it is certainly not in the patient's best interest.
At the non-profit I worked at, the ratio was five to six aides per 50 residents, or 1:8, or so.  Ask for a patient to staff ratio when touring any potential facility for your Granny.

Ask what the staff longevity is at any home you tour. You should find a fairly stable staff base, with minimal turnover(three will always be some). At the non-profit that employed me, 51% of employees had been there five years or longer.  better at non-profits.

All homes these days can make a good first impression with fancy lobbies, offices  and sitting rooms. First impressions can be misleading, though. What is the purpose of having Louis XIV chairs in the lobby if the people who LIVE THERE are not permitted to sit on them?

Non-profits have better "stuff" for the residents. By "stuff, I mean the incidentals: A better grade of toilet tissue, real juice versus kool-aid, thicker towels and washcloths, softer sheets.  While I am sure there are fabulous for-profit homes that also supply high quality incidentals, , I personally have not seen it often.. It is something to look for when choosing Granny's home for her autumn years. 

Non-profits rely on fund raisers for many "extra's". Fund raisers are great ways to encourage a sense of camaraderie among the staff, thus, boosting morale. It instills a sense of pride to know that staff's efforts helped buy the new wheelchair van, or even the new popcorn machine for movie day.

In closing, I hope this article helps, should you find yourself in a position to need the services of a nursing home. Yes, I readily admit that I am biased on the side of the non-profit, but I offer my opinion as a stepping stone only. Research the home where your loved one will LIVE thoroughly. Remember, you only have to visit, but Granny has to spend 24/7 in the place.