Predicting turnover and retention in nursing home administrators: management and policy implications

Determinants of voluntary turnover: A data-driven analysis for blue and white collar workers

BACKGROUND

There is a growing interest in HR-analytics because of its ability to analyze employee behavior based on HR data. Predicting voluntary turnover of employees is an important topic of study, both in academia and industry.

OBJECTIVE

The current study analyzes determinants for turnover, distinguishing between blue and white collar workers. The turnover analyses are based on a dataset from a payroll company, in contrary to previous turnover studies that used survey and interview data.

METHODS

The studied dataset contains demographic and work specific factors for more than 380000 employees in 15692 Belgian corporations. Logistic regression is used to estimate individual turnover probabilities, the goodness of the model is tested with the AUC method.

RESULTS

The study confirms turnover determinants and differences between blue and white collar workers that were described in previous work based on survey and interview data. Additionally, the study exposes so far unstudied turnover determinants and differences between blue and white collar workers. Confirmed determinants are among others age, seniority, pay and work distance. New determinants are company car, meal vouchers, night work and sickness. Different relationships to turnover are revealed for blue and white collar workers based on gender, number of children, nationality and pay.

CONCLUSIONS

The presented dataset-based approach has its merit in analyzing turnover: it enables to study actual turnover instead of turnover intentions, and reveals new turnover determinants and differences between blue and white collar workers.

Assuring Quality in Nursing Homes: The Black Box of Administrative and Clinical Leadership—A Scoping Review

Background and Objectives

Licensed nursing home administrators (NHA) and directors of nursing (DON) are responsible for nursing home quality and assuring optimal performance and job satisfaction/retention of their nursing home workforce. NHA/DON-focused studies have generated important foundational knowledge over the last three decades; yet, targeted research is needed to understand and apply the complexities of the black box of this top management team. This scoping review identifies, reviews, synthesizes, and maps the topical areas of research in NHA/DON positions in U.S. nursing homes.

Research Design and Methods

We conducted searches of 5 databases, yielding 3,479 records; screening/review yielded 88 unique records. We used thematic analysis to code the primary foci of the studies and the variables associated with the concepts of interest.

Results

Most papers (n = 40) focused on role characteristics, 23 examined approaches to management and leadership, 24 focused on perceptions about the role, and the remaining 12 examined role structure. The role-related themes linked to outcomes (n = 42), processes (n = 27), and structures (n = 30).

Discussion and Implications

We highlight important gaps for future research and offer a call to action for research, policy, practice, and education collaborations to accelerate the rate of research and translate the findings into best practices for NHA/DON to lead and manage the nursing home workforce and build capacity to ensure person-centered, high-quality care. Based on foundational descriptive studies, it is time to use what is known to design and implement interventions that enhance the capacity of NHA/DON to improve the structures, processes, and outcomes of nursing homes.

Nursing Home Administrator's Job Satisfaction, Work Stressors, and Intent to Leave

This study examines how job satisfaction in six subscales and select stressors and demographic covariates influence nursing home administrator's (NHA) intentions to quit. Quantitative and qualitative data were collected from 311 NHAs in five states. Adjusted odds ratios and 95% confidence intervals for the ordered logistic regression models indicated that NHAs with satisfying work demands, rewards, and coworkers, and who experienced less role conflict and had fewer prior nursing home jobs had lower turnover intentions. Although generally satisfied, roughly 24% reported intending to quit. Surprisingly, NHAs reporting higher job skills were more likely to consider leaving, suggesting that talented NHAs may choose career advancement eased by stigma-free job-hopping in an industry with high mobility norms. Qualitative data suggested that job satisfaction/dissatisfaction was influenced by a more nuanced interpretation of satisfying and more taxing job facets and quitting triggers, including themes such as helping residents and struggling with regulations.

Correlates of Administrator Tenure in US Residential Care Communities

OBJECTIVE

To determine community- and individual-level correlates of administrator tenure in US residential care communities (RCCs).

DESIGN

Secondary data analysis of the 2010 National Survey of Residential Care Facilities designed by the National Center for Health Statistics. Analysis was conducted using Tobit regression.

SETTING AND PARTICIPANTS

A nationally representative sample of RCCs in the United States (n = 2302).

MEASURES

The outcome measure for this study is RCC administrator tenure. Residential care community characteristics include chain ownership, size, occupancy rate, profit status, years of operation, if the building was purposely constructed as an RCC, Medicaid census, presence of a dementia care unit, and whether administrative staff provided care. Administrator characteristics included age, gender, race/ethnicity, and level of education.

RESULTS

Over a quarter of administrators in this sample remained employed with the same RCC for 10 or more years (28%). Chain membership, community size, and presence of a dementia care unit are associated with shorter administrator tenure (P < .001). Communities with greater than 80% occupancy, administrator's age 40+, and Hispanic race/ethnicity were associated with longer administrator tenure (P < .001).

CONCLUSIONS/IMPLICATIONS

Various community and administrator characteristics are associated with shorter or longer tenure within the same community. More setting-specific research is needed to identify how RCC administrators influence care quality and what different lengths of tenure indicate in the context of RCC operations.

Quality Improvement in Nursing Homes: Alignment Among Leaders Across the Organizational Chart

Background and Objectives

This article describes nursing home (NH) leaders' involvement in quality improvement (QI) decisions, with an emphasis on the concept of alignment in QI decisions across leaders.

Research Design and Methods

We used a qualitative approach and semistructured interviews to collect data from a convenience sample of 39 NH leaders, including corporate/executive-level leaders and facility-level leaders. Thematic analysis was used to inductively capture key patterns in data.

Results

Variations in alignment emerged as a major theme to describe the interface and interaction among facility- and corporate/executive-level leaders around QI decision making and implementation of QI decisions. For this study, alignment refers to the extent of shared understanding, beliefs, motivations, and implied or explicit agreement among leaders in regards to: (a) goals, values, priorities, and expectations for quality or QI (and/or applicable resources); and (b) expectations for leaders to carry out QI decisions made by other leaders.

Discussion and Implications

This study offers new insights into the complexities associated with leadership alignment toward improving NH quality. The findings provide a glimpse into leaders' involvement in QI based on their position on the facility's organizational chart and extend our understanding of the centrality of the concept of alignment in promoting QI. These findings may inform future research on facility- and corporate/executive-level leader interactions and how these interactions impact quality outcomes.

Predicting voluntary turnover through human resources database analysis

Purpose

This paper aims to question whether the available data in the human resources (HR) system could result in reliable turnover predictions without supplementary survey information.

Design/methodology/approach

A decision tree approach and a logistic regression model for analysing turnover were introduced. The methodology is illustrated on a real-life data set of a Belgian branch of a private company. The model performance is evaluated by the area under the ROC curve (AUC) measure.

Findings

It was concluded that data in the personnel system indeed lead to valuable predictions of turnover.

Practical implications

The presented approach brings determinants of voluntary turnover to the surface. The results yield useful information for HR departments. Where the logistic regression results in a turnover probability at the individual level, the decision tree makes it possible to ascertain employee groups that are at risk for turnover. With the data set-based approach, each company can, immediately, ascertain their own turnover risk.

Originality/value

The study of a data-driven approach for turnover investigation has not been done so far.

A scoping review of nursing workforce planning and forecasting research

AIM

This study will critically evaluate forecasting models and their content in workforce planning policies for nursing professionals and to highlight the strengths and the weaknesses of existing approaches.

BACKGROUND

Although macro-level nursing workforce issues may not be the first thing that many nurse managers consider in daily operations, the current and impending nursing shortage in many countries makes nursing specific models for workforce forecasting important.

METHOD

A scoping review was conducted using a directed and summative content analysis approach to capture supply and demand analytic methods of nurse workforce planning and forecasting. The literature on nurse workforce forecasting studies published in peer-reviewed journals as well as in grey literature was included in the scoping review.

RESULTS

Thirty six studies met the inclusion criteria, with the majority coming from the USA. Forecasting methods were biased towards service utilization analyses and were not consistent across studies.

CONCLUSION

Current methods for nurse workforce forecasting are inconsistent and have not accounted sufficiently for socioeconomic and political factors that can influence workforce projections. Additional studies examining past trends are needed to improve future modelling.

IMPLICATIONS FOR NURSING MANAGEMENT

Accurate nursing workforce forecasting can help nurse managers, administrators and policy makers to understand the supply and demand of the workforce to prepare and maintain an adequate and competent current and future workforce.

Work Life Stress and Career Resilience of Licensed Nursing Facility Administrators

Career resilience provided a frame for understanding how Licensed Nursing Facility Administrators (LNFAs) sustain role performance and even thrive in stressful skilled nursing facility work environments. Quantitative and qualitative analyses of in-depth interviews with18 LNFAs, averaging 24 years of experience were conducted by a five-member research team. Analysis was informed by evidence-based frameworks for career resilience in the health professions as well as the National Association of Long-Term Care Administrator Boards' (NAB) five domains of competent administrative practice. Findings included six sources of work stressors and six sources of professional satisfaction. Also, participants identified seven strategic principles and 10 administrative practices for addressing major sources of stress. Recommendations are provided for research and evidence-based application of the career resilience perspective to LNFA practice aimed at reducing role abandonment and energizing the delivery of the quality of care that each resident deserves.

Job Satisfaction of Nursing Home Administrators and Turnover

We know little about factors associated with job satisfaction and dissatisfaction for nursing home workers. In this investigation, the authors use data from a large sample of nursing home administrators (NHAs) to examine: (1) their levels of job satisfaction, (2) whether job satisfaction is associated with intent to leave, (3) whether job satisfaction is associated with turnover after 1 year, and (4) whether job satisfaction after 1 year varies for NHAs who left based on where they subsequently worked. Overall, NHAs were more satisfied with the job satisfaction subscales of: rewards, work skills, and workload but were less satisfied with work demands and coworkers. NHAs appeared particularly sensitive to work skills, with this area of job satisfaction being associated with intent to turnover and actual turnover. In general, the authors found a stronger association with job satisfaction and actual turnover than with intent to turnover.

Nursing Homes with Persistent High and Low Quality

This article examines the concentration of low- and high-quality care within particular nursing facilities over time. The authors explore three different explanations for persistent low and high quality over time including the level of public reimbursement, the presence of bed constraint policies such as certificate-of-need and construction moratoria, and the role of consumer information. Using 1991 through 1999 data from the On-Line Survey, Certification, and Reporting system, the authors show that both low- and high-quality nursing home care is concentrated in certain facilities over time. Their results further show that public reimbursement and asymmetric information are both important factors in explaining why low quality persists over time in certain facilities.

An Exploration of Nursing Home Organizational Processes

The purpose of this study is to explore the relationship between nursing home staffs' perceptions of organizational processes (communication, teamwork, and leadership) with characteristics (turnover, tenure, and educational preparation) of the nursing home administrator (NHA) and director of nursing (DON). NHAs and DONs rate communication, teamwork, and leadership significantly higher than direct care staff do (registered nurses, licensed practical nurses, certified nurse aides [CNAs]). CNAs have the lowest ratings of communication and teamwork. Turnover of the NHA and DON is significantly and negatively associated with communication and teamwork. Two thirds of DONs surveyed hold less than a baccalaureate degree; this does not influence staffs' ratings of communication, teamwork, and leadership. Findings from this study highlight the need to explore differences in perceptions between administrative and direct care staff and how these may or may not influence staff development and quality improvement activities in nursing homes.

Use of Resident Satisfaction Surveys in New Jersey Nursing Homes and Assisted Living Facilities

In this article, the authors present the results of a questionnaire inquiring into the use and usefulness of resident satisfaction surveys sent to all nursing homes (N = 363) and assisted living facilities (N = 152) in New Jersey in fall 2000. The authors found 86% of nursing homes and 88% of assisted living facilities to be using resident satisfaction surveys. Satisfaction information was reported as extremely useful or very useful in 72% of nursing homes and 83% of assisted living facilities. However, satisfaction instruments used by nursing homes and assisted living facilities are highly varied, and instruments appear to have been developed largely on an ad hoc basis, with little attention to testing of validity or psychometric properties. Standardization initiatives are clearly needed. In addition, the uses of satisfaction information were limited and primarily aimed at administrative goals rather than at improving quality of care. These factors may restrict the potential benefits of resident satisfaction information.

Top management leadership style and quality of care in nursing homes

PURPOSE

The purpose of this study was to examine the association of Nursing Home Administrator (NHA) leadership style and Director of Nursing (DON) leadership style with quality of care.

DESIGN AND METHODS

Leaders were categorized into 4 groups: consensus managers, consultative autocrats, shareholder managers, or autocrats. This leadership style assessment came from primary data collected from approximately 4,000 NHAs and DONs that was linked to quality information (i.e., Nursing Home Compare Quality Measures and 5-Star rating scores) and nursing home information (i.e., Online Survey, Certification, And Reporting data).

RESULTS

A consensus manager leadership style has a strong association with better quality. Top managers using this style solicit and act upon input from their employees. For NHAs exhibiting this leadership style, the coefficients on 5 of the 7 quality indicators are statistically significant, and all 7 are significant when the DON exhibits this style. When the NHA and DON both have a consensus manager leadership style, 6 of the 7 quality indicator coefficients are significantly associated with better quality.

IMPLICATIONS

The findings indicate that NHA and DON leadership style is associated with quality of care. Leadership strategies are amenable to change; thus, the findings of this study may be used to develop policies for promoting more effective leadership in nursing homes.

Staffing levels in rural nursing homes: a mixed methods approach

This mixed methods study used multiple regression analyses to examine the impact of organizational and market characteristics on staffing hours and staffing mix, and qualitative interview to explore the challenges and facilitators of recruiting and retaining qualified staff. Rural nursing homes (NHs) certified by Medicare or Medicaid (N = 161) were sampled from the Online Survey Certification and Reporting system. A subsample (n = 23) was selected purposively for the qualitative analysis. Smaller NHs or government-affiliated homes had more total nursing hours per resident day and more hours of care by certified nursing assistants and RNs than larger and nongovernment-affiliated homes; however, almost 87% of NHs in this study were below the national recommendation for RN hours. Informants voiced challenges related to enough staff, qualified staff, and training staff. Development of nursing resources is critical, especially in rural locales where aging resources may not be well developed.

Relationship of the Job Tenure of Nursing Home Top Management to the Prevalence of Pressure Ulcers, Pain, and Physical Restraint Use

The association of job tenure among nursing home administrators (NHAs) and directors of nursing (DONs) with the prevalence of pressure ulcers, pain, and physical restraint use was examined. Data sources included the 2004 National Nursing Home Survey and quality measures from the Centers for Medicare and Medicaid Services. Regression models examined NHA tenure ( n = 787) and DON tenure ( n = 703). Control variables included prior prevalence of the respective outcome, NHA/DON education, and facility characteristics among others. Increasing NHA and DON tenure were both associated with decreases in the prevalence of pressure ulcers and pain but not restraint use. DON tenure had more impact on outcomes in earlier stages of tenure than NHA tenure. Effects of NHA tenure were in later stages of tenure. Increasing tenure among NHAs and DONs may influence better resident outcomes within their facility.

Does Quality Pay for Nursing Homes?

Using physical restraints, urethral catheterization, pressure ulcers, psychotropic medication use, and contractures as quality indicators, this research examines whether the quality of nursing homes is associated with private-pay census. The primary data source was the 2000, 2001, and 2002 Online Survey Certification And Recording (OSCAR) data, which is nationally representative data containing information for approximately 17,000 nursing homes. The results of this study suggest that physical restraint use and psychotropic medication use have both a correlative and predictive relationship with private-pay census. Catheterization, pressure ulcers, and contractures are less important. The results of this study are important in two ways. First, the cross-sectional results show that the higher quality nursing homes are likely to have a higher private-pay census. Second, the change score analyses show that nursing homes can increase their private-pay census by increasing quality.

An analysis of nursing home quality measures and staffing

PURPOSE

The purpose of this retrospective study was to evaluate nursing home quality measures (QMs) available in a national database called Nursing Home Compare. The aim was to determine whether differences in QM scores occurred with changing staffing-level mix.

SUBJECTS

All Missouri nursing home facilities were included for the analysis of the 14 QMs downloaded in February 2004.

METHODS

Analyses of variance were used to examine differences in the dependent QM scores; the independent range of staffing levels for 3 disciplines, certified nurse assistant (CNA), licensed practical nurse (LPN), and registered nurse (RN), was analyzed on the basis of their number of hours per resident per day worked in the nursing home. Planned contrasts and post hoc Bonferroni adjustments were calculated to further evaluate significance levels. Finally, residents were used as a covariate to determine effects on significant analyses of variance.

RESULTS

Care is proportionate to the percentage of CNA/LPN/RN staffing-level mix, with 2 long-stay QMs (percentage of residents who lose bowel or bladder control and percentage of residents whose need for help with activities of daily living has increased) and 2 short-stay measures (percentage of residents who had moderate to severe pain and percentage of residents with pressure ulcers) revealed differences in mean quality scores when staffing levels changed.

Exploring the Influence of the Regulatory Survey Process on Nursing Home Administrator Job Satisfaction and Job Seeking

Nursing home administrators’ retention rate continues to be a serious problem. One factor potentially affecting administrator turnover that has received minimal research attention is the nursing home regulatory process. Using a random start systematic sample of 135 nursing home administrators, this study explores whether regulatory process perceptions, survey performance (number of deficiency citations on last survey), and demographic or facility variables are associated with job satisfaction and job seeking. Multivariate analyses revealed three main findings: (a) an overall positive perception of the survey process was a significant predictor of administrator job satisfaction and job seeking, (b) survey performance outcomes were not related to administrator job satisfaction, and (c) administrator job seeking was associated with perception of the survey process, performance outcomes, and four factors identified in prior research on staff turnover (type of facility, job tenure, salary, and job satisfaction). Results reinforce ongoing initiatives on retaining quality nursing home leadership.

Nursing Home Administrators’ Attribution of Antifacility Bias to Ombudsman Programs

The federally mandated ombudsman program is a part of a deterrence approach to improving nursing home care. The author investigated whether nursing home administrators’(NHAs) views of volunteer resident advocates’ work would predict attributions of antifacility bias to ombudsman programs. Both quantitative and qualitative data were analyzed from questionnaires completed by 199 NHAs. Perceptions of volunteers as aggressive and as hindrances, the belief that issues would be resolved without the program, and little contact with volunteers predicted an antifacility bias. There were four types of administrators who articulated needed improvements in ombudsman programs: positive activists, adversarials, collaborators, and educators. Strained relationships between NHAs and those who monitor them may increase facility and agency turnover and diminish the efforts of both. Research on person-environment fit for facility and ombudsman positions should be useful for those who train, license, certify, or hire these personnel.

Measuring Staff Turnover in Nursing Homes

PURPOSE

In this study the levels of staff turnover reported in the nursing home literature (1990-2003) are reviewed, as well as the definitions of turnover used in these prior studies. With the use of primary data collected from 354 facilities, the study addresses the various degrees of bias that result, depending on how staff turnover is defined in nursing homes.

DESIGN AND METHODS

Data came from a survey mailed to administrators of 526 nursing homes during March 2003. Facilities were located in four states: Missouri, Texas, Connecticut, and New Jersey. Three hundred and fifty-four responses were received, giving a response rate of 67%.

RESULTS

The 1-year turnover rates identified in these facilities were 119%, 89%, 87%, 57%, and 48%, for nurse aides, licensed practical nurses, registered nurses, administrators, and directors of nursing, respectively. However, findings show that the definition of turnover used could influence the relative difference between these reported rates by as much as 47%.

IMPLICATIONS

As a result of measurement error, turnover rates may be misrepresented in prior studies. On the basis of the results of this investigation, several recommendations are made for future data-collection initiatives that will eliminate some of this measurement error.

Turnover Begets Turnover

Purpose: This study examined the association between turnover of caregivers and turnover of nursing home top management. The top managers examined were administrators and directors of nursing, and the caregivers examined were registered nurses, licensed practical nurses, and nurse aides. Design and Methods: The data came from a survey of 419 nursing facilities and the Online Survey, Certification, and Reporting system. Multinomial logistic regression analyses were used to examine the association between turnover of nursing home top management and turnover of caregivers. Results: A 10% increase in top management turnover is associated (p &lt;.05) with a 21% increase in the odds that a facility will have a high turnover rate of nurse aides and is associated (p &lt;.05) with an 8% decrease in the odds that a facility will have a low turnover rate of nurse aides. A 10% increase in top management turnover is associated (p &lt;.1) with a 30% increase in the odds that a facility will have a high turnover rate for registered and licensed practical nurses. Implications: This study provides preliminary evidence that the turnover of top managers may have an important influence on caregiver turnover in nursing homes.

The extent of quality improvement activities in nursing homes

The quality of nursing home care has long been a cause for concern. The federal government has recently launched the Nursing Home Quality Initiative, in which Quality Improvement Organizations assist nursing homes in quality improvement (QI) activities. In addressing how well nursing homes are prepared for QI, this article examines the sort of QI activities that nursing homes are currently undertaking and the preparation of Administrators and Directors of Nursing to lead QI efforts. Drawing on data from surveys of 2 random samples of Kansas nursing homes, the article concludes that questions about QI activities in nursing homes tend to elicit socially acceptable answers unless the questions are carefully structured; that few nursing homes appear to have functioning QI programs; and that high leadership turnover and limited leadership training make it difficult for nursing homes to sustain effective QI programs.

Providing outcomes information to nursing homes: can it improve quality of care?

PURPOSE

This study examined whether providing outcomes information to 120 nursing homes facilitated improvements in quality over a 12-month period, as compared with 1,171 facilities not receiving this information. The outcomes information provided consisted of a report mailed to administrators that examined six measures of care quality. These were the rates of physical restraint use, urethral catheterization, contractures, pressure ulcers, psychotropic medication use, and certification survey quality of care deficiencies.

DESIGN AND METHODS

Data used in this investigation came from the 1998 and 1999 On-line Survey, Certification and Recording (OSCAR) system. With the use of generalized least squares regression and each of the six quality indicators as dependent variables, risk-adjustment models were developed by using aggregate resident variables as independent variables. These risk-adjustment models were used to compare the outcome measures for the intervention facilities with the same outcome measures in other facilities in the same states (Kansas, Maine, Mississippi, New York, Texas, and South Dakota). The difference between 1998 predicted scores less actual scores was calculated, and the difference between 1999 predicted scores less actual scores for each facility was calculated. Subtracting these 1998 difference scores from the 1999 difference scores gives some indication of the change in outcomes controlling for resident mix.

RESULTS

Physical restraint use and psychotropic medication use were significantly lower after 12 months in the intervention facilities, suggesting that quality had improved.

IMPLICATIONS

This study may provide evidence that some of the outcomes initiatives currently being pursued in the long-term care arena will positively affect quality of care.

Nursing homes with persistent deficiency citations for physical restraint use

OBJECTIVES

This paper examines the organizational and aggregate resident characteristics of nursing homes associated with persistent poor quality in the use of physical restraints. Deficiency citations for physical restraint use in two and three consecutive certification survey inspections are used as our measures of poor quality.

MATERIALS AND METHODS

Nationally representative data from the 1996, 1997, 1998, and 1999 Online Survey, Certification, and Reporting system are used, first, to provide descriptive analyses. Second, multinomial logistic regression analyses are used to examine organizational and aggregate resident characteristics associated with deficiency citations for restraint use on any survey inspection, on two consecutive inspections, and deficiencies for physical restraint use in three consecutive inspections.

RESULTS

It is shown that 729 (5.2%) nursing homes had deficiency citations for restraint use on two consecutive inspections and 317 (2.3%) on three consecutive inspections. Persistent poor quality in the use of physical restraints in nursing homes is negatively associated to higher staffing levels of care givers, and positively associated to higher Medicaid census, and higher average activities of daily living (ADL) levels.

CONCLUSION

The Nursing Home Reform Act has been extremely influential in reducing the overall prevalence of physical restraint use in nursing homes, but the number of facilities with persistent quality problems in their use of restraints in the face of this legislation is surprising. The organizational and aggregate resident characteristics of these nursing homes, especially RN staffing levels, Medicaid census, and average ADL levels differ from those that did not receive any deficiency citations for use of physical restraints.

Nursing home administrator compensation: pay equity and determinants of salary

This study evaluates the issue of gender-based pay inequality. Male NHAs earn 7 percent more than female NHAs, but factors such as education, experience, tenure, facility size, ownership, location, competition, and emphasis on private pay census account for the difference. The findings, however, indicate that racial inequalities and gender differences among married NHAs may be present, requiring further investigation. Key implications of the results are discussed.

External threats and nursing home administrator turnover

External threats and volatility in the long-term-care sector in recent decades have posed serious challenges for nursing home administrators. Greater job complexity and administrative responsibilities resulting from public policies and more specialization and competitiveness in nursing home markets have made turnover a significant issue. This article examines administrator turnover from 1970 through 1997 in New York State and describes how turnover increased markedly in the late 1980s and early 1990s.

Administrator turnover and quality of care in nursing homes

PURPOSE OF THE STUDY

In this article, I examine the association between turnover of nursing home administrators and five important quality of care outcomes.

DESIGN AND METHODS

The data came from a survey of 420 nursing facilities and the 1999 On-line Survey, Certification, and Reporting System. Using multivariate logistic regression analyses, I looked at the effects of turnover of administrators in nursing homes belonging to chain organizations and in nursing homes not belonging to chain organizations.

RESULTS

I found the average annual turnover rate of administrators to be 43%. The multivariate logistic regression analyses show that in nursing homes belonging to chains, administrator turnover is associated with a higher than average proportion of residents who were catheterized, had pressure ulcers, and were given psychoactive drugs and with a higher than average number of quality-of-care deficiencies. In nursing homes not belonging to chains I found that turnover of administrators is associated with a higher than average proportion of residents who were restrained, were catheterized, had pressure ulcers, and were given psychoactive drugs.

IMPLICATIONS

There is a need to improve understanding of how and why better outcomes are achieved in some nursing homes. This investigation serves to focus attention on nursing home administrators. I believe this study provides preliminary evidence that the turnover of administrators may have an important association with quality of care in nursing homes.