Privatization in Long-Term Care Homes

This paper is a product of our major collaborative research initiative, “Reimagining Long-Term Residential Care: An International Study of Promising Practices”. The initiative brought together in 2010 Principal Investigator Pat Armstrong with 26 faculty from six countries (Canada, Germany, Norway, Sweden the UK, and the US) and from a dozen academic disciplines in addition to sociology. About 60 graduate students, postdoctoral fellows and research associates have also participated.

We employ two main methodologies: analytical mapping and rapid, site-switching ethnography. Mapping enables us to examine developments on issues such as legislation and regulations, funding, access, quality measures, staffing models and levels, and outcomes. In our ethnographic approach, teams of 12 to 14 researchers together spend up to a week observing and interviewing in one of the 27 nursing homes we have visited. Some bring long experience in nursing home research; others bring fresh eyes to the sector. Over 50 publications have resulted from our collective teamwork.

It has become increasingly clear that financing and ownership issues have an impact on the project’s other three central themes: work organization, approaches to care, and accountability and governance. The impact is demonstrably felt at the level of public and non-profit vs. for-profit ownership. The focus here is on several other forms of privatization. We examine the insertion by branches of for-profit nursing home chains and consulting firms into the management of non-profit and public homes. We consider the adoption of the practices and the language of business in these homes. We explore the influence of increasing for-profit ownership on the state’s regulatory, inspection and data collection activities. We assess how restrictions on the numbers of publicly funded nursing home spaces impose in turn increased burdens on that other private realm, the household, and on the predominantly unpaid female workers there.