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 For-Profit Nursing Homes Saw Lower Risk Of Falls, University Study Finds

For-profit, independent nursing homes were less likely to have newly admitted residents fall than their counterparts, a new study by the University of Southern California and Brown University has found.

At least one in every five newly admitted residents fell within 30 days of entering a nursing home, the study found. Reviewing data for calendar year 2006, researchers studied more than 274,000 first-time residents in more than 15,000 nursing homes and assigned what they called “adjusted odds ratios” that those residents were likely to fall within 30 days of their admissions.

For-profit, independently owned homes had the lowest odds ratio—0.91, the study found. For-profit, chain nursing homes were next at 0.98, and nonprofit, chain homes had 1.04, the researchers said. Nonprofit, independent homes were used as the baseline to measure the rest of the field, lead researcher Natalie Leland, PhD, says.

“This finding is not consistent with previous studies [that] found for-profit and independently owned facilities are associated with a poorer quality of care,” the study said.

The study, released in late May, may be the first of its kind to study fall rates among newly admitted nursing home residents.

It was too early to draw conclusions about the findings, researchers said, acknowledging that their methodology may have skewed the data. “In the present study, [nursing homes] were required to have a minimum of 13 new admissions in 2006,” they wrote.

“Previous studies have predominantly focused on long-stay residents. Placing a facility-level requirement on the minimum number of new resident admissions may have resulted in a [nursing home] cohort with a greater emphasis on rehabilitation rather than chronic maintenance care.”

“Additionally, the results may represent a selection bias that was not controlled for the covariates included in the model,” the authors said. “Individuals admitted to for-profit, independently owned facilities were younger, took fewer medications, and had fewer falls in the 30 days prior to admission, all indicators of lower fall risks.”

Still, further research is needed, the study’s authors concluded. Among the study’s other findings:

  • Nursing homes with bigger certified nurse assistant (CNA) staff had lower risks of falls. “For every one-hour increase in CNA hours per resident, per day, there was a 3 percent decrease in the odds of a fall among this cohort,” the authors wrote.
  • Nearly 54 percent of fall victims suffered from congestive heart failure, nearly 30 percent suffered from depression, almost 28 percent from diabetes, and more than 27 percent from dementia.
  • Nearly one-quarter—22. 2 percent—of fall victims were taking antipsychotic medications, compared with 18.7 percent of “nonfallers.”
  • Medications, in fact, correlated with fall risk: “Similarly, for every additional medication taken, the odds of a fall increased 1 percent, with the average resident in the cohort taking 10.1 … medications,” the authors wrote.
  • Nearly 38 percent of those who fell had used a cane, crutches, or walker, compared with a little more than 32 percent of nonfallers.​
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