[Trade-off between quality, price, and profit orientation in Germany's nursing homes]

International data suggest that for-profit nursing homes tend to provide lower quality than not-for-profit nursing homes. In Germany, the relationships between profit orientation, price and quality of nursing homes have not been investigated.

We performed an observational study using secondary data from statutory quality audits of all nursing homes in Germany. The relationships were analyzed bivariately via Mann-Whitney U- and Kruskal-Wallis test, respectively, followed by a multivariate analysis of variance which also covered the interaction effect between quality, price and type of ownership.

41% of 10,168 German nursing homes were for-profit organizations charging on average about 10% less than not-for-profit homes. In five out of six quality categories under study, for-profit nursing homes provided lower quality than not-for-profit homes. Quality of care in all quality categories improved with higher cost per day. However, with four out of six quality categories examined, the quality difference between for-profit and non-profit nursing homes persisted, irrespective independently of the price.

When selecting a nursing home it is therefore advisable to consider the profit orientation of the institution. German legislation should require that statutory public quality reports contain details on the profit orientation of nursing homes.