A new study is challenging the long-held belief that for-profit nursing homes deliver worse outcomes for residents living with dementia — at least when it comes to pain.
Researchers from the University of Maryland School of Nursing found no statistically significant connection between a facility’s ownership status and whether residents with dementia experienced documented pain. The findings were published Feb. 19 in the journal Pain Management Nursing.
The analysis included 553 residents across 55 nursing homes in Maryland and Pennsylvania. Roughly 61% of the facilities were for-profit. Overall, 23.3% of residents — fewer than one in four — had pain documented during the study period.
After accounting for residents’ health conditions, cognitive status and publicly reported quality ratings, ownership type did not show a meaningful association with observed pain. The study reported an odds ratio of -0.88 for profit status and pain, with a 95% confidence interval ranging from -1.86 to 0.10 and a p-value of .08.
Quality Ratings and Cognition Matter More
While profit status was not a significant factor, other variables were.
Facilities with higher Centers for Medicare & Medicaid Services (CMS) Care Compare ratings were associated with lower odds of observed pain among residents. Although the study did not outline specific rating thresholds, the trend was clear: higher overall quality scores correlated with better pain outcomes.
Cognitive function also played a notable role. Using the Brief Interview for Mental Status (BIMS), researchers found that each one-point drop in a resident’s score was linked to roughly a 10% decrease in the odds that pain would be observed and recorded. In practical terms, residents with more severe cognitive impairment were less likely to have their pain identified.
The study’s abstract noted that nearly one in five nursing home residents with dementia experience pain symptoms, highlighting how common — and potentially underrecognized — the issue remains.
Pain Management Remains Complex
The research drew on cross-sectional secondary data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) study. Investigators connected resident-level clinical data with facility characteristics, including ownership and CMS quality metrics.
Although profit status was not statistically tied to pain outcomes, the authors suggested ownership structures could still influence how facilities approach treatment. Nonpharmacologic interventions — often labor-intensive and resource-heavy — remain underused in dementia care, they noted.
Given the challenges of assessing and managing pain in this population, the researchers called for greater clinical and policy focus on improving outcomes. They also urged future studies to explore a broader range of organizational factors, including different types of for-profit entities, and how those structures may relate to pain management.
The study was conducted by Sorah Levy, Barbara Resnick and Elizabeth Galik of the University of Maryland School of Nursing and published under the auspices of the American Society for Pain Management Nursing.
