Comparative Performance of Private Equity–Owned US Nursing Homes During the COVID-19 Pandemic
Authors: Robert Tyler Braun, Hyunkyung Yun, Lawrence P. Casalino, Zachary Myslinski, Farai M. Kuwonza, Hye-Young Jung, Mark Aaron Unruh
Journal: JAMA Network Open (2020)

<h3>Importance</h3> It is not known whether nursing homes with private equity (PE) ownership have performed better or worse than other nursing homes during the coronavirus disease 2019 (COVID-19) pandemic. <h3>Objective</h3> To evaluate the comparative performance of PE-owned nursing homes on COVID-19 outcomes. <h3>Design, Setting, and Participants</h3> This cross-sectional study of 11 470 US nursing homes used the Nursing Home COVID-19 Public File from May 17, 2020, to July 2, 2020, to compare outcomes of PE-owned nursing homes with for-profit, nonprofit, and government-owned homes, adjusting for facility characteristics. <h3>Exposure</h3> Nursing home ownership status. <h3>Main Outcomes and Measures</h3> Self-reported number of COVID-19 cases and deaths and deaths by any cause per 1000 residents; possessing 1-week supplies of personal protective equipment (PPE); staffing shortages. <h3>Results</h3> Of 11 470 nursing homes, 7793 (67.9%) were for-profit; 2523 (22.0%), nonprofit; 511 (5.3%), government-owned; and 543 (4.7%), PE-owned; with mean (SD) COVID-19 cases per 1000 residents of 88.3 [2.1], 67.0 [3.8], 39.8 [7.6] and 110.8 [8.1], respectively. Mean (SD) COVID-19 deaths per 1000 residents were 61.9 [1.6], 66.4 [3.0], 56.2 [7.3], and 78.9 [5.9], respectively; mean deaths by any cause per 1000 residents were 78.1 [1.3], 91.5 [2.2], 67.6 [4.5], and 87.9 [4.8], respectively. In adjusted analyses, government-owned homes had 35.5 (95% CI, −69.2 to −1.8;<i>P</i> = .03) fewer COVID-19 cases per 1000 residents than PE-owned nursing homes. Cases in PE-owned nursing homes were not statistically different compared with for-profit and nonprofit facilities; nor were there statistically significant differences in COVID-19 deaths or deaths by any cause between PE-owned nursing homes and for-profit, nonprofit, and government-owned facilities. For-profit, nonprofit, and government-owned nursing homes were 10.5% (9.1 percentage points; 95% CI, 1.8 to 16.3 percentage points;<i>P</i> = .006), 15.0% (13.0 percentage points; 95% CI, 5.5 to 20.6 percentage points;<i>P</i> &lt; .001), and 17.0% (14.8 percentage points; 95% CI, 6.5 to 23.0 percentage points;<i>P</i> &lt; .001), respectively, more likely to have at least a 1-week supply of N95 masks than PE-owned nursing homes. They were 24.3% (21.3 percentage points; 95% CI, 11.8 to 30.8 percentage points;<i>P</i> &lt; .001), 30.7% (27.0 percentage points; 95% CI, 17.7 to 36.2 percentage points;<i>P</i> &lt; .001), and 29.2% (25.7 percentage points; 95% CI, 16.1 to 35.3 percentage points;<i>P</i> &lt; .001) more likely to have a 1-week supply of medical gowns than PE-owned nursing homes. Government nursing homes were more likely to have a shortage of nurses (6.9 percentage points; 95% CI, 0.0 to 13.9 percentage points;<i>P</i> = .049) than PE-owned nursing homes. <h3>Conclusions and Relevance</h3> In this cross-sectional study, PE-owned nursing homes performed comparably on staffing levels, resident cases, and deaths with nursing homes with other types of ownership, although their shortages of PPE may warrant monitoring.