Privatized Nursing Homes Linked to More Hospitalizations for Older Australians, Large Study Finds

A sweeping analysis of more than 200,000 older Australians living in residential aged care has found that the type of organization that owns a nursing home is measurably associated with the health outcomes of its residents, with those in government-owned facilities experiencing fewer emergency department presentations and fewer unplanned hospital admissions than their counterparts in not-for-profit and for-profit homes. The study, published in BMJ Open by researchers at Flinders University, arrives at a moment when the ownership landscape of Australia’s aged care sector is shifting rapidly, as large commercial providers acquire facilities that were previously operated by charitable and community-based organizations. The findings add hard epidemiological evidence to a debate that has intensified since the Royal Commission into Aged Care Quality and Safety documented systemic problems across the sector.

The research drew on the Registry of Senior Australians national cohort, covering the period from 2013 to 2018, and examined emergency department admissions and unplanned hospital admissions among long-term care residents. In total, 205,079 residents were included in the analysis. Of these, 8,961 residents, or 4.4 percent, lived in government-owned facilities, 105,144 residents, or 51.3 percent, lived in not-for-profit homes, and 90,974 residents, or 44.4 percent, lived in homes owned by for-profit companies. This distribution itself illustrates a structural feature of Australian aged care: government-owned homes now represent only a small fraction of the sector, while commercial operators account for nearly half of all residents studied.

Lead author Dr Miia Rahja of Flinders University explained that the study was designed to compare different nursing home ownership models while also accounting for a factor that is often overlooked in such analyses: geographic location. The researchers found that residents of government-owned aged care homes had fewer hospital-related events overall, and that the differences between ownership types were most pronounced in Australia’s inner-regional areas. Residents in government-owned homes had a lower risk of emergency department presentation than residents in not-for-profit homes, and similar patterns were observed for unplanned hospitalizations and for the number of days residents spent in hospital, with the associations holding across various regions of the country.

The technical significance of the study lies in its population-based retrospective cohort design, which allowed the researchers to observe outcomes across an entire national population of aged care residents rather than a selected sample. By linking ownership data with hospitalization records, the team could quantify differences in acute health service use that are clinically meaningful: every emergency department presentation and every unplanned admission represents a disruption to an older person’s care, an exposure to hospital-acquired risks, and a cost to the health system. Days spent in hospital are particularly consequential for frail older adults, because transitions out of familiar care environments are associated with functional decline, delirium, and medication errors.

The findings come at a time when ownership patterns in Australia’s aged care sector are changing in ways that make the research especially timely. Several large providers have acquired aged care homes that were previously operated by not-for-profit organisations, a consolidation process that has reduced the total number of providers in the sector from 663 in 2023 to 642 in 2024. While consolidation can bring economies of scale, the study’s results suggest that the consequences of transferring facilities from mission-driven to commercially oriented ownership deserve close scrutiny, because the ownership model itself appears to be associated with how often residents end up in hospital.

Senior author Professor Maria Inacio, who heads the Registry of Senior Australians Research Centre, known as ROSA, and the Flinders Ageing Alliance at Flinders University, emphasized that ongoing monitoring of aged care home ownership is vital because ownership has significant potential impact and consequences on residents’ outcomes. She noted that the findings from the study agree with the investigations of the Royal Commission into Aged Care Quality and Safety regarding the influence of aged care home ownership on the quality and outcomes of individuals living in these facilities. The Royal Commission, which delivered its final report after extensive public hearings and evidence gathering, had already flagged concerns about how financial structures and profit motives shape the day-to-day care that older Australians receive.

The new study does not stand alone. Prior research has shown that for-profit providers are less likely to be compliant with sector requirements, such as mandatory care minutes, which set minimum staffing time that must be delivered to each resident. Compliance with such requirements is a direct measure of whether a facility is meeting its obligations under the regulatory framework, and lower compliance among commercial operators has been a recurring theme in sector audits and academic evaluations. Taken together with the hospitalization findings, this body of evidence points to a consistent pattern in which ownership incentives correlate with the intensity and quality of care delivered at the bedside.

Dr Rahja stated that the work confirms the need for financial, quality, and social accountability monitoring of aged care home integration, given the significant influence that ownership has on resident outcomes. This recommendation carries practical weight for policymakers. Australia’s aged care system is funded substantially through government subsidies, and hospitalizations of aged care residents generate additional costs that flow through state and territory health systems. If ownership type is associated with different rates of acute care use, then monitoring frameworks that track only financial solvency or basic quality indicators may be missing a crucial dimension of sector performance. Integrating ownership data into routine outcome surveillance would allow regulators to detect deteriorating patterns before they translate into avoidable hospitalizations.

The study, titled ‘The association of long-term care facility ownership and location on residents’ mortality and hospitalisations: A population-based retrospective cohort study in Australia’, was authored by Miia Rahja, Ling Davies, Robert Jorissen, Maria Crotty, Craig Whitehead, Keith Evans, Megan Corlis, Carly Meyer, Gillian Caughey and Maria Inacio, and was published in BMJ Open on 21 September 2026. The research method was data and statistical analysis, and the subject of the research was people, specifically the large cohort of older Australians whose hospitalization histories were tracked across the study period. The publication carries the DOI 10.1136/bmjopen-2026-11791 and appeared in the flagship British Medical Journal group’s open-access general medical journal.

For older Australians and their families, the study underscores that the question of who owns a nursing home is not merely a matter of corporate structure but one that can shape the likelihood of an emergency ambulance trip or an unexpected admission to a hospital ward. As the sector continues to consolidate and as the balance between for-profit, not-for-profit, and government ownership shifts, the researchers argue that transparency about ownership and its consequences must become a permanent feature of aged care oversight. With nearly half of the residents in the national cohort living in for-profit facilities, and with the number of providers shrinking year on year, the stakes of getting this policy balance right extend to hundreds of thousands of older people and the health system that cares for them.

Subject of Research: The association between nursing home ownership type and hospitalization outcomes among older Australians

Article Title: Older Australians face higher risks as more nursing homes are privatized

Article References: Older Australians face higher risks as more nursing homes are privatized. (n.d.). Original publication

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Keywords: aged care, nursing homes, privatization, hospitalization, Australia, BMJ Open, Flinders University, for-profit care, emergency department, health policy, older adults, Registry of Senior Australians