Relationship between the Ownership Status of Nursing Homes and Their Outcomes During the COVID-19 Pandemic: A Rapid Literature Review

Context: Some nursing homes fared better than others to protect themselves against the 2019 coronavirus disease (COVID-19). Organisational characteristics may mediate the effect of the COVID-19 pandemic. Previous reviews have suggested for-profit providers provide worse quality of care. Does ownership also matter in the response to the COVID-19 pandemic? Objective: The aim of this literature review is to evaluate the relationship between ownership structure of nursing homes and their performance during the pandemic, measured as COVID-19 cases and deaths. Method: A rapid literature review was conducted in PubMed and Web of Science, following a systematic approach. The search was conducted in October 2020 and updated in December 2020. Articles were selected based on a pre-defined set of PICOT criteria and underwent risk of bias assessment. Findings: Eighteen papers were included in this rapid review. These papers cover a period from March to July 2020. The majority of papers found a significant relationship in the unadjusted statistics between ownership status and effectiveness in response to the COVID-19 pandemic. However, the adjusted figures paint a more nuanced picture. The relationship seems to be mediated by other organisational (e.g., size), process (e.g., staff shortages) and contextual factors (e.g., regional spread of COVID-19) in comparison to ownership directly. Limitations: The majority of the included studies focus on North America, and most studies are of low to medium quality with respect to research methodology. Implications: In the short-term, it will likely be more effective to address identified mediating factors of the relationship between ownership and COVID-19 outcomes; but for the long-term, this review is in keeping with previous literature suggesting policymakers should be cautious about encouraging the ownership of nursing homes by for-profit providers.