Nonprofit and for-profit home care in Israel: clients' assessments

Clients' assessments of differences between nonprofit and for-profit organizations delivering home care services to Israel's frail elderly were studied. No significant differences were found between nonprofit and for-profit providers with respect to organizational efficiency; speed of placement and replacement of home care workers; responsiveness to clients' complaints; and supervision of care plans, schedules, and service delivery. Systematic differences were found, however, in clients' perceptions of workers employed by nonprofit versus for-profit service providers. The differences related to the home care workers' adaptation to clients' needs and wants; how well workers delivered services; and how satisfied clients were with the services received. Indications are that the relatively high efficiency of nonprofit organizations can largely be attributed to the performance of their home care workers.     

A Focus on the Program of All-Inclusive Care for the Elderly (PACE)

For over four decades, the Program of All-Inclusive Care for the Elderly (PACE) has been operated by nonprofit organizations. Research has demonstrated that nonprofit PACE provides quality, cost-effective community-based care to older adults who would otherwise require a nursing home level of care. Recently, the U.S. Secretary of the Department of Health and Human Services has authorized for-profit entities to operate PACE, contingent on their ability to demonstrate that they can provide care that is similar to nonprofit PACE with regard to access to care, quality of care, and cost-effectiveness. In 2013, a study was conducted to evaluate how PACE operates under for-profit versus nonprofit status. The results were presented to Congress which, in turn, authorized for-profit PACE providers. This article critiques the 2013 study, offers a comparison to for-profit hospice, and argues that at best there is not enough evidence to conclude that for-profit PACE provides the same quality of care as existing nonprofit operators.     

Strengthening Social Protection in East Asia,Mukul G. Asher and Fukunari Kimura (Eds.)

Few studies have analyzed for-profit and nonprofit differences in the home health care sector. Using data from the National Home and Hospice Care Survey, we found that patients in nonprofit agencies were more likely to be discharged within 30 days under Medicare cost-based payment compared to patients in for-profit agencies. However, this difference in length of enrollment did not translate into meaningful differences in discharge outcomes between nonprofit and for-profit patients, suggesting that—under a cost-based payment system—nonprofits may behave more efficiently relative to for-profits. These results highlight the importance of organizational and payment factors in the delivery of home health care services.     

Changing Relationships Between Nonprofit and For-profit Human Service Organizations Under the Long-Term Care System in Japan

In Japan, a nonprofit organization system enacted in the late 1990s and the later introduction of privatization policies in human services were expected to overturn government dominance of nonprofit organization activities. By focusing on the long-term care insurance (LTCI) system, which privatized public human services for the first time in the country, this study empirically examines whether, and to what extent, nonprofit–government relationships in Japan have actually changed as a result of this new system. In addition, because LTCI newly allows for-profit organizations to provide services, the influence of such organizations were incorporated into the analysis. The outcomes of this study demonstrate that the government continues to extend its sphere of influence over nonprofit and for-profit organizations through LTCI. In addition, for-profit organizations appear to be more successful than nonprofit organizations, in that the former organizations have overcome their lack of experience as public service providers by taking over the roles that nonprofit organizations have traditionally occupied.     

Innovation,Professional Interests,and Nonprofit Organizations: The Case of Health Care in Poland

Nonprofit organizations have a role in spreading technological innovation. The experience in Poland illustrates that entrepreneurial health care professionals prefer nonprofit organizations over for-profit organizations to introduce novel services to the market because nonprofits create favorable public perceptions of those services.     

Quality Differences of Public,For-Profit and Nonprofit Providers in Scandinavian Welfare? User Satisfaction in Kindergartens

VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations - Research on differences between public, for-profit, and nonprofit providers of welfare services has provided mixed...     

"Walking the Walk" of Public Service Motivation: Public Employees and Charitable Gifts of Time, Blood, and Money

Research generally indicates that public employees "talk thetalk," but do they also "walk the walk" of the public servicemotive (PSM)? Are public service employees more likely thanothers to engage in public service activities? The behavioralimplications of PSM are addressed by studying the involvementin charitable activities of public, nonprofit, and private workers.Using data from the 2002 General Social Survey, multivariatelogistic regression models are estimated to examine self-reportedgifts of time, blood, and money to charitable organizations.It is found that government employees are more likely to volunteerfor charity and to donate blood than for-profit employees are.Additionally, nonprofit workers are also more likely than theirfor-profit counterparts to volunteer. However, no differenceis found among public service and private employees in termsof individual philanthropy. These findings generally lend supportfor the hypothesis that PSM is more prominent in public servicethan in private organizations, especially as it pertains togovernment personnel.     

Client Satisfaction with Live-In and Live-Out Home Care Workers in Israel

Abstract

In an era of globalization where the migration of long-term care workers is common, foreign live-in home care workers can compensate for the unavailability of family members and, perhaps, even substitute for institutional care in the provision of long-term care services to disabled older persons.

This study examines differences in home care satisfaction between disabled older persons in Israel with “live-in” home care workers and those with “live-out” workers, and explores some differences in socio-demographic and personal characteristics between these two groups. Face-to-face interviews were held with a random sample of 93 older persons in Beer-Sheva.

Older persons with live-in home care workers were more satisfied with their home care service than those with live-out workers. Those with live-in workers were more severely disabled, tended not to have any children living in close proximity, although an adult child was available as an informal caregiver. Communication difficulties between the elderly persons and their home care workers were found not to affect negatively the satisfaction with the service.     

Client satisfaction with live-in and live-out home care workers in Israel

In an era of globalization where the migration of longterm care workers is common, foreign live-in home care workers can compensate for the unavailability of family members and, perhaps, even substitute for institutional care in the provision of long-term care services to disabled older persons. This study examines differences in home care satisfaction between disabled older persons in Israel with "live-in" home care workers and those with "live-out" workers, and explores some differences in sociodemographic and personal characteristics between these two groups. Face-to-face interviews were held with a random sample of 93 older persons in Beer-Sheva. Older persons with live-in home care workers were more satisfied with their home care service than those with live-out workers. Those with live-in workers were more severely disabled, tended not to have any children living in close proximity, although an adult child was available as an informal caregiver. Communication difficulties between the elderly persons and their home care workers were found not to affect negatively the satisfaction with the service.     

Child center closures: Does nonprofit status provide a comparative advantage?

Reliable access to dependable, high quality childcare services is a vital concern for large numbers of American families. The childcare industry consists of private nonprofit, private for-profit, and governmental providers that differ along many dimensions, including quality, clientele served, and organizational stability. Nonprofit providers are theorized to provide higher quality services given comparative tax advantages, higher levels of consumer trust, and management by mission driven entrepreneurs. This study examines the influence of ownership structure, defined as nonprofit, for-profit sole proprietors, for-profit companies, and governmental centers, on organizational instability, defined as childcare center closures. Using a cross sectional data set of 15724 childcare licenses in California for 2007, we model the predicted closures of childcare centers as a function of ownership structure as well as center age and capacity. Findings indicate that for small centers (capacity of 30 or less) nonprofits are more likely to close, but for larger centers (capacity 30 +) nonprofits are less likely to close. This suggests that the comparative advantages available for nonprofit organizations may be better utilized by larger centers than by small centers. We consider the implications of our findings for parents, practitioners, and social policy.     

How Do They Fit?

Abstract

Despite public policies that promote an increased role for faith-based organizations in the delivery of publicly supported services, insufficient attention has been paid to assessing how service delivery by faith-based and secular providers might differ. This study considers the issues involved in evaluating the role of faith-based organizations within the broad context of a community's social service offerings. Criteria are developed for assessing role differences by comparing the types of services, delivery approaches, and service locations offered by different types of providers. The approach is then illustrated using a large sample of social service providers in Los Angeles County. Important role differences are revealed. Faith-based organizations offer fewer and different types of services than their secular counterparts. The results suggest a modest and focused role for faith-based organizations in social service delivery, but one that is complementary to the efforts of secular providers. The methodological issues raised by such analyses are highlighted.     

Facility Ownership and Resident Satisfaction with Assisted Living

Abstract

Although the majority of assisted living facilities operate as for-profit organizations and serve increasingly frail elderly populations, little is known about the impact of ownership on the quality of care in assisted living. This study examines the relationship between facility ownership and the quality of care in assisted living, using resident satisfaction as a quality indicator. The assessed aspects of satisfaction include health care, housekeeping, physical environment, relationships with staff, and social life/activities. The relationship of facility ownership to resident satisfaction is examined controlling for resident psychological well-being, functional ability, facility size, and staff resources. Data were collected in personal interviews with 156 residents, including 96 residents in eight for-profit facilities and 60 residents in five nonprofit facilities in Maryland. Residents in the sampled nonprofit facilities were more satisfied with assisted living than were residents in the for-profit facilities. In particular, residents in nonprofit facilities were more satisfied with health care, physical environment, and social life/activities in the facility. Better understanding of the relationship between facility ownership and resident satisfaction can help administrators create environments that maximize resident satisfaction in both nonprofit and for-profit facilities.     

Combined Effects: The Influence of Organizational Form and Structural Characteristics on Contract Performance in Mixed Sector Markets

Social service contracting to nongovernmental organizations is popular form of privatization across the world. Although nonprofits are preferable social service providers for legal and normative reasons, governments in the United States increasingly rely on for-profit organizations to deliver social services. This trend warrants further exploration about whether nonprofits or for-profits perform according to theoretical expectations when they exist in the same market. This study employs qualitative comparative analysis (QCA) to examine how sector-public, nonprofit, and for-profit-combines with structural variables to produce acceptable contract performance in juvenile justice programs. QCA is a discovery-oriented research tool that determines whether combinations of variables within cases produce a specific outcome and whether those combinations are consistent across cases. I find sector is not a necessary or sufficient predictor of acceptable performance on its own. Rather it combines with market factors to lead to acceptable contract performance. Combinations vary by sector, indicating that sectors behave differently in similar circumstances. The primary theoretical contribution of this paper is to provide a nuanced account of contract performance in mixed sector markets.     

Performance evaluations of for‐profit and nonprofit U.S. hospitals since 1980

This synthesis of studies examines whether the published literature shows an evidence‐based consensus on performance differences between private for‐profit and nonprofit hospitals in the United States since 1980. The author systematically and comprehensively surveyed peer‐reviewed publications to clarify this question. The author's second objective was to learn what proportion of all research assessing for‐profit and nonprofit health care providers is devoted to hospitals compared to all other providers. The third goal was to discover how any trends in observed performance differences among hospitals compare with trends among other provider types. Computerized bibliographic searches of all relevant databases yielded seventy‐five studies (ninety‐three assessments) that compared the performance of for‐profit and nonprofit hospitals on four performance criteria: access, quality, cost or efficiency, and amount of charity care. The author coded findings on performance in one of three ways: for‐profit superiority, nonprofit superiority, or inconclusive. Most studies (60 percent) reported that nonprofit hospitals have better relative performance than for‐profit hospitals, clear evidence of their organizational effectiveness. Thirty‐one percent were inconclusive, and 8 percent reported that for‐profits were better.     

Beyond Cans and Capacity

Many essential public services are provided through networks of community‐based nonprofit organizations. Previous research has demonstrated that simply providing additional resources to these organizations is insufficient to better address demands for public services. We also know little about how and why these organizations adopt network‐level objectives related to service provision. In this analysis, we expand the focus of service provision beyond capacity to incorporate the unique roles that define the very existence of nonprofit organizations, and how these roles affect organizational behavior with respect to service network objectives. We use focus group, survey, and administrative data from one hundred community‐based nonprofit organizations in an emergency food service network to explore the relationships among capacity, roles, and specific program objectives.     

Gendered,Invisible Work in Non‐profit Social Service Organizations: Implications for Worker Health and Safety

Nonprofit organizations (NPOs) play an important role in the provision of health and social services. In Canada the nonprofit sector includes 7.5 million volunteers and employs over 1.6 million paid workers. The sector is overwhelmingly female‐dominated — women make up over 80 per cent of workers in these nonprofit services. Work performed by women has traditionally been undervalued and invisible. It has often been considered safe by researchers, employers, policymakers and sometimes even workers themselves. Although there is some indication that jobs in the restructuring social services sector can be characterized by constant demand, high stress and violence, research into the working conditions and health hazards of these types of jobs has not been a priority. Using data from a qualitative study examining work in NPOs, we trace the ways that work performed in these workplaces is both gendered and invisible. We identify three types of invisible labour. ‘Background work’ facilitates and supports more visible and recognized organizational activities. Certain organizational language obscures the full spectrum of work that takes place in the organizations and the risks it may involve. ‘Empathy work’ includes the relationship building, counselling and crisis intervention that comprise key components of social service delivery. ‘Emotional labour’ involves the management of client emotions and workers' own emotions in the process of working with clients and delivering care under conditions of scarcity and contraction. The invisibility of these activities means that much of the day‐to‐day work done in the organizations, while particularly important in the context of social service restructuring, is taken‐for‐granted and undervalued by organizational outsiders. As a result, many of the hazards present in the jobs are hidden from view and workers' health may be compromised. We argue that the invisibility and taken‐for‐grantedness of certain types of work in NPOs is reflected in, and constitutive of, particular exclusions and shortcomings of current occupational health and safety systems designed to protect the health of workers.     

Assessing Value Differences Between Leaders of Two Social Venture Types: Benefit Corporations and Nonprofit Organizations

This study considers key value differences between leaders of two types of social ventures: for-profit social benefit corporations and nonprofit organizations. The research question asks to what degree the value sets of leaders of benefit corporations are congruent with those of similarly situated individuals in nonprofit organizations. The results show the values of leaders working in benefit corporations and nonprofit organizations are in many ways aligned, but there are notable statistical differences. A sectoral association of values is also present with employees in both types of organization, especially when the previous work experience of employees is considered.     

The growth of the nonprofit sector in the 1980s: Facts and interpretation

The nonprofit sector was the growth sector of the 1980s. This is the conclusion reached from detailed examination of the growth trends of major industry groups in New York State in the years 1981 through 1987. The analysis in this article suggests that the growth of the nonprofit sector was due primarily to the strong orientation of the economy toward services, where the nonprofit sector has traditionally had an important presence. Within service industries as a whole, the nonprofit and for-profit sectors grew at comparable rates; however, nonprofit growth was concentrated in semipublic services and in services where information is often difficult for consumers to acquire and understand, while the for-profit sector grew in simpler and more privately oriented services. The analysis shows that the nonprofit sector filled much of the gap left by reduced or stagnating government services. However, the growth of the nonprofit sector may be difficult to sustain in the future if sufficient entrepreneurial talent and other resources are not forthcoming.     

Contrasting perspectives of parents and service providers on respite care in Queensland,Australia

Abstract

Parent-carers need support to continue to care for their child with significant disability in their home. There has, however, been little evidence that respite interventions have consistent or enduring beneficial effects on carer well-being. This article reports the findings of a qualitative study which adopted an Appreciative Inquiry philosophy to interview parent-carers of children with significant intellectual and/or developmental disabilities on how formal support services have helped them maintain their health and well-being, and disability support staff on how they help such parent-carers foster their health and well-being. We conclude that better communication and collaboration between service providers and users, more targeted training of workers, and embracing a person-centred and family-centred approach to respite services are needed. In addition, clearer definition and communication of the scope of respite services are required to best support families of children with significant disability in their home.     

Managing Risk in Community Care of Older People: Perspectives from the Frontline

Abstract

Since the mid-1980s, Australian governments have focused on expanding community and home-based services for older people. This has led to increased levels of dependency, vulnerability, and complexity to be managed in the community. Consequently, aged care services have had to develop mechanisms for regulating and managing these increased risks, and risk management has become more central to the practices of professional workers in this field. This paper reports on some findings from a large-scale study that explores the way risk management policies have been translated into practice by community-based services in Victoria, Australia. Drawing on interviews with 18 frontline and management professionals employed in community aged care, we found that these workers were wrestling with a diverse and new range of institutional risks beyond those encountered in the actual delivery of frontline care. We found that these workers experienced “risk” in four different contexts, which often created demands for contradictory or conflicting responses. Here we examine these “contexts of risk practice”: professional workers' relationships with their clients, relationships with other service providers, the unregulated nature of the home as a work environment, and community expectations about the management of risk. Despite tensions that frequently arose, workers expressed strong professional commitments to their clients and were motivated to find positive resolutions amid competing interests. We conclude that tensions experienced by workers were embedded in the structural dimensions of institutional relationships and the systematic absence of shared understandings of “acceptable” risks in the community care of older people, rather than in the failure of professional agency.