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Why Many American Nursing Homes Are Like McDonald’s

As far as we know, there aren’t tons of nursing homes out there serving Big Macs or Chicken McNuggets to their residents. So why, then, do we have this title—that nursing homes in the United States are like McDonald’s?


This is in large part thanks to a recent Transformation Tuesday event Gray Panthers held, where a panelist noted parallels between nursing homes and a McDonald’s. And the parallels, while not obvious unless you think about it, are striking.


McDonald’s is, technically speaking, a real estate company where they own the property and have franchises. The same can be said for nursing homes run by larger companies, because nursing homes (and long-term care), is also about real estate.


McDonald’s franchises have an obligation, even a fiduciary duty, to make a profit for their companies. So do nursing homes under the banner of these larger entities.


But here’s the issue: when we are talking about McDonald’s, we are not talking about an entity where lives are at stake depending on how they treat their customers. But with nursing homes, lives are at stake dependent upon how these nursing home entities and their franchisees treat their own customers, the nursing home residents.


And yet, because the fiduciary duty of a nursing home under a larger nursing home profit making corporation, is similar to that of a McDonald’s the priority is not on the wellbeing of the residents if wellbeing does not make money for the nursing home. It means money is not getting spent in the way it should—for the care of its own residents.


This is all the more reason why systemic transformation of nursing homes is needed in the United States. But, in the interim, what we need is transparency when it comes to how nursing homes spend their money. This transparency will allow the public to hold accountable nursing homes not spending money as they should, while holding as a model any nursing homes that do invest in its residents to the level they should.


How likely is it that the powers that be in the nursing home industry will just go along with any push for transparency without a battle? Not very, because for some nursing homes, the general public will likely find out an ugly, unsavory truth that profits are being prioritized over people. In spite of that, and perhaps because of that, such transparency is an important step on the road towards nursing home justice.

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