ABSTRACT
This chapter examines the structural features of the nursing home market and the industry itself in an effort to identify factors related to poor quality of care. It argues that regulatory efforts, while essential, are not sufficient to improve the overall quality of nursing home care. The nursing home industry has more proprietary ownership and chain ownership than any other segment of the health system, with the exception of the drug industry. One of the major debates in research, policy, and consumer advocacy circles is whether the proprietary nature of the nursing home industry negatively affects access, costs, and quality of care. Staffing levels are directly associated with ownership, with proprietary facilities having lower staffing levels. The nursing home industry is well-represented by highly paid professionals with extensive organizational resources for lobbying government. The nursing home industry is growing in size and importance as a provider of long term care.
