In response to recent media attention on the issue of ownership and nursing home quality, policymakers have focused attention on issues of oversight and accountability.  In particular, lawmakers have raised questions about the extent to which it is desirable and feasible to focus nursing home quality measurement and quality assurance at the level of ownership rather than the facility.  Broadening the focus of nursing home regulation and quality measurement requires a level of systematic evaluation and enforcement beyond what occurs currently. Such reforms could be effective, though, if quality of care is heavily influenced by practices, policies, and systems that are inherent to ownership.

A key lynchpin in researching and enforcing policy directives around nursing home ownership is having timely, detailed data about ownership structures and management arrangements. Importantly, Federal datasets are not yet able to facilitate these tasks adequately. On-Line Survey Certification and Reporting (OSCAR) data offer only cursory information about owners, and the Provider Enrollment, Chain, and Ownership System (PECOS) data have faced multiple implementation challenges.  In this project, we use detailed ownership data available from the state of Texas to address several policy and research questions including, but not limited to the following:

* What are the corporate structures of nursing homes in Texas and how have they changed over time? What relationships exist between the business entities holding the nursing home license and any third-party ownership, such as private equity firms? How do corporate structures differ by for-profit and non-profit facilities?

* What is the relationship between corporate structure, third-party ownership (such as private equity firm), multi-facility status, profit status and other facility characteristics with quality of care and staffing measures?