Author ORCID Identifier

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Public Management and Policy

First Advisor

Janelle A. Kerlin

Second Advisor

Omar I. Asensio

Third Advisor

Andrew Heiss

Fourth Advisor

Jennifer C. Morgan

Fifth Advisor

Momotazur Rahman


This dissertation presents a quantitative analysis of the association between ownership types and quality of services in the long-term care sector in the United States. The study employs dynamic difference-in-differences models to investigate the effects of for-profit ownership conversions on nursing home quality indicators by drawing on national-level panel data for the years between 2013 and 2021. Additionally, the adverse effects of information asymmetries are examined by comparing changes in government-inspected quality measures with changes in self-reported quality measures following a for-profit conversion of a nursing home. Furthermore, the impact of the recent regulatory changes implemented at the end of 2016 in the nursing home sector and the facility-level factors associated with the COVID-19 pandemic outcomes in nursing homes are examined with respect to the quality trends and differences in quality by ownership types. Lastly, this study explores the relationship between ownership and quality in assisted living facilities in the State of Georgia using state inspection data. Overall, this dissertation finds that for-profit ownership status is associated with worse quality outcomes among nursing homes and assisted living facilities, including adverse outcomes of the COVID-19 pandemic. Moreover, the analyses show that the recent regulatory reforms had little to no effect on improving the quality of nursing homes over time. The findings are discussed to help policymakers formulate new policies and effective regulations to improve the quality of long-term care.