scholarly journals COVID-19 Death in High-Medicaid Nursing Homes: The Role of Employment Empowerment

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 522-523
Author(s):  
Ganisher Davlyatov ◽  
Justin Lord ◽  
Akbar Ghiasi ◽  
Robert Weech-Maldonado
Keyword(s):  
Decision Making ◽  
Nursing Home ◽  
Nursing Homes ◽  
Secondary Data ◽  
Lower Number ◽  
Employee Empowerment ◽  
Income Poverty ◽  
Organizational Size ◽  
Open Communication ◽  
For Profit

Abstract This study examines the association between COVID-19 death and employee empowerment in under-resourced nursing homes (70% or higher Medicaid census). Employee empowerment captures elements of participative decision making, autonomy, responsibility, open communication, decentralization, and decision-making flexibility within an organization. Survey data from 391 Directors of Nursing (response rate of 37%) from 2017-2018, were merged with secondary data from CMS Nursing Home COVID-19 Public File, LTCFocus, Area Health Resource File, and Nursing Home Compare. A Poisson regression was used to examine reported COVID-19 death and employee empowerment. The independent variable employee empowerment was the mean score of summated Likert scale questions. Control variables included organizational (size, location, ownership, chain affiliation, quality, payer mix, acuity, occupancy, and race/ethnicity, staffing mix), and county factors (Medicare Advantage penetration, per capita income, poverty, unemployment, education, 65+ population, and competition). Employee empowerment was associated with a lower number of COVID-19 cases (p < 0.05). Rural, not-for-profit, and payer-mix were also significantly associated with a lower number of COVID-19 deaths. Employee empowerment captures the decentralization of authority and an employee’s ability to make decisions without approval. In light of this crisis, empowerment may have helped under-resourced nursing homes be more agile and faster in their response. High-Medicaid nursing homes may need to consider different decision-making practices when faced with a crisis, such as, COVID-19.

scholarly journals The Impact of Leadership Styles on Quality and Financial Performance in High Medicaid Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 22-22
Author(s):  
Justin Lord ◽  
Ganisher Davlyatov ◽  
Akbar Ghiasi ◽  
Robert Weech-Maldonado
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Financial Performance ◽  
Leadership Styles ◽  
Reference Group ◽  
Secondary Data ◽  
Income Poverty ◽  
Trade Offs ◽  
Autocratic Leadership ◽  
The Impact

Abstract This study examines the association between leadership styles on resident quality and financial performance in under resourced nursing homes (70% or higher Medicaid census). The Bonoma/Slevin leadership model was used to classify managers into four categories, autocrat, consultative autocrat, consensus manager, and shareholder manager. Survey data from 391 nursing home directors (response rate of 37%) from 2017- 2018, were merged with secondary data from LTCFocus, Area Health Resource File, Medicare Cost Reports, and Nursing Home Compare. Two models were ran to examine the effect of leadership styles on the dependent variable(s) nursing home STAR data (quality) and operating margin (financial performance). The independent variables were composite scores for leadership styles, with autocrat as the reference group. Control variables included organizational (ownership, chain affiliation, size, occupancy, payer mix, staffing, and race/ethnicity), and county factors (Medicare Advantage penetration, per capita income, poverty, education, unemployment, and competition). Multivariate regression was used to model the relationship between leadership styles and nursing home quality and financial performance. The consultative autocrat was associated with lower quality (p < 0.05), while the consensus manager was associated with lower profit margin (p < 0.05), as compared to autocratic leadership. The consultative autocrat, who solicits information from the staff yet still makes all significant decisions, is associated in lower quality; however, a consensus manager, who delegates their authority to the group, is associated with lower financial performance. Under-resourced nursing homes who face dual pressures need to recognize trade-offs of different decision making styles for quality and financial performance.

scholarly journals Malpractice Environment vs Direct Litigation: What Drives Nursing Home Exit?

2018 ◽  
Vol 55 ◽  
pp. 004695801878799
Author(s):  
R. Tamara Konetzka ◽  
Hari Sharma ◽  
Jeongyoung Park
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Fixed Effects ◽  
Online Survey ◽  
Market Competition ◽  
Consumer Welfare ◽  
Data Sets ◽  
For Profit ◽  
The Impact ◽  
The Relationship

An ongoing concern about medical malpractice litigation is that it may induce provider exit, potentially affecting consumer welfare. The nursing home sector is subject to substantial litigation activity but remains generally understudied in terms of the effects of litigation, due perhaps to a paucity of readily available data. In this article, we estimate the association between litigation and nursing home exit (closure or change in ownership), separating the impact of malpractice environment from direct litigation. We use 2 main data sources for this study: Westlaw’s Adverse Filings database (1997-2005) and Online Survey, Certification and Reporting data sets (1997-2005). We use probit models with state and year fixed effects to examine the relationship between litigation and the probability of nursing home closure or change in ownership with and without adjustment for malpractice environment. We examine the relationship on average and also stratify by profit status, chain membership, and market competition. We find that direct litigation against a nursing home has a nonsignificant effect on the probability of closure or change in ownership within the subsequent 2 years. In contrast, the broader malpractice environment has a significant effect on change in ownership, even for nursing homes that have not been sued, but not on closure. Effects are stronger among for-profit and chain facilities and those in more competitive markets. A high-risk malpractice environment is associated with change of ownership of nursing homes regardless of whether they have been directly sued, indicating that it is too blunt an instrument for weeding out low-quality nursing homes.

Illusions of Affection: Bureaucratic Ritualization's Relation to Emotional Abuse and Neglect in Nursing Homes

2009 ◽  
Vol 33 (3) ◽  
pp. 238-257 ◽  
Author(s):  
Jason S. Ulsperger ◽  
J. David Knottnerus
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Emotional Abuse ◽  
Nursing Home Residents ◽  
For Profit ◽  
The Poor ◽  
Structural Ritualization Theory ◽  
Abuse And Neglect ◽  
Poor Treatment ◽  
Everyday Interaction

This research uses 40 ethnographies, biographies, and autobiographies to explore various symbolic themes expressed through everyday interaction in nursing homes. The themes involve bureaucratic concepts such as staff separation, rules, documentation, and efficiency. They also involve ideas of emotional abuse and neglect, like objectification, compassion transgressions, and spiritual negligence. Relying on structural ritualization theory, we argue ritualized symbolic practices of bureaucracy unintentionally facilitate attitudes and acts of emotional neglect in both for-profit and nonprofit nursing homes. This assists in the development of rituals facilitating the poor treatment of residents. Overall, we propose that if society is going to have humane care for nursing home residents, it must first understand the ritual dynamics that lead to employees viewing and treating those they care for with a lack of dignity.

Relocation experiences with unplanned admission to a nursing home: a qualitative study

2016 ◽  
Vol 29 (3) ◽  
pp. 517-527 ◽  
Author(s):  
Andrea Luise Koppitz ◽  
Jutta Dreizler ◽  
Jeanine Altherr ◽  
Georg Bosshard ◽  
Rahel Naef ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Hospital Discharge ◽  
Qualitative Content Analysis ◽  
Secondary Data ◽  
Unplanned Admission ◽  
Convenience Sample ◽  
Face To Face ◽  
The Usa ◽  
Unplanned Admissions

ABSTRACTBackground:In many countries, people over 85 years of age are relocated involuntarily or unplanned to a nursing home. In Switzerland, 43% of elderly over 85 years are admitted to nursing homes after hospital discharge. This percentage is higher than in the USA with 32.5% or in Germany with only 19%. Despite those more frequent Swiss admissions, no research has been conducted exploring how unplanned admissions to nursing homes affect the adaptation. Therefore, the aim of this study was to gain an in-depth understanding into unplanned admissions to nursing homes and to explore its impact on adaptation.Methods:The study used a qualitative interview design based on Meleis’ transition model. Secondary data analysis was guided by Mayring's qualitative content analysis. Face-to-face interviews with elderly over 77 years (n= 31) were conducted from a convenience sample in Switzerland between January and March 2013.Results:The following four patterns of adaptation emerged from the analysis: “being cut-off,” “being restricted,” “being cared for,” and “moving on.” The patterns evaluate the relocation into nursing homes and provide an opportunity to appraise the stages of adaption.Conclusions:This study presents a model of analysis to evaluate patterns of adaptation following an unplanned admission to a nursing home after hospital discharge.

Ethics of Assisted Autonomy in the Nursing Home: Types of Assisting Among Long-Term Care Nurses

1996 ◽  
Vol 3 (3) ◽  
pp. 224-235 ◽  
Author(s):  
June M. Whitler
Keyword(s):  
Decision Making ◽  
Nursing Home ◽  
Nursing Homes ◽  
Long Term Care ◽  
Personal Autonomy ◽  
Self Determination ◽  
Decisional Capacity ◽  
Term Care ◽  
Ethical Implications

Twenty-five long-term care nurses in eight nursing homes in central Kentucky were inter viewed concerning ways in which they might assist elderly residents to preserve and enhance their personal autonomy. Data from the interviews were analysed using grounded theory methodology. Seven specific categories of assisting were discovered and described: personalizing, informing, persuading, shaping instrumental circumstances, considering, mentioning opportunities, and assessing causes of an impaired capacity for decision-making. The ethical implications of these categories of assisting for clinical prac tice are examined. Although nurses recognized the importance of resident autonomy, the majority of them failed consistently to employ the categories of assistance to foster resi dent self-determination and most of them held an inadequate understanding of the con cepts of consent and decisional capacity. To assure confidentiality, pseudonyms are used in the following cases and discussions for all names of nurses, residents and facilities.

scholarly journals Nursing Home Factors and Their Impact on COVID-19 Cases: A Study of Wisconsin State

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 884-884
Author(s):  
Mohammed Abahussain ◽  
Priya Nambisan ◽  
Colleen Galambos ◽  
Bo Zhang ◽  
Elizabeth Bukowy
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Missing Values ◽  
Organizational Factors ◽  
Data Sets ◽  
Occupancy Rate ◽  
Free Standing ◽  
Staff Shortage ◽  
For Profit ◽  
Nurse Aides

Abstract COVID-19 has been devastating for Nursing Homes (NHs). The concentration of older adults with underlying chronic conditions inevitably made the setting highly vulnerable leading to high rates of mortality for residents. However, some nursing homes fared better than others. This study examines several quality measures and organizational factors to understand whether these factors are associated with COVID-19 cases in Wisconsin. We combined three datasets from Centers for Medicare & Medicaid Services (CMS) – the Star Rating dataset, Provider Information dataset and COVID-19 Nursing Home dataset. Data used is from the period of Jan 1 – Oct 25, 2020 for the state of Wisconsin. The analysis includes 331 free-standing NHs with no missing values from the data sets. The variables used were self-reported information on nursing home ratings, staff shortage, staff reported hours, occupancy rate, number of beds and ownership. Of the 331 NHs examined, shortages were reported of 25.4%, 31.1%, 3.2% and 15.6% of licensed nurse staff (25.4%), nurse aides (31.1%), clinical staff, (3.2%) and other staff (15.6%) Additionally, there was a significant (p<.05) positive correlation between number of beds and COVID-19 cases, and there was no statistically significant association between occupancy rate and COVID-19 cases. NHs with better star ratings were also found to have less COVID-19 cases. Interestingly, private NHs had significantly higher COVID-19 cases than for-profit and government owned NHs, a finding that is congruent with other studies in this area. Recommendations for practice will be discussed.

scholarly journals For-Profit Nursing Homes in the Netherlands: What Factors Explain Their Rise?

2020 ◽  
Vol 50 (4) ◽  
pp. 431-443 ◽  
Author(s):  
Aline Bos ◽  
Florien Margareth Kruse ◽  
Patrick Paulus Theodoor Jeurissen
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
The Netherlands ◽  
Nonprofit Organizations ◽  
Private Equity ◽  
Nonprofit Sector ◽  
Nursing Home Care ◽  
Specialist Care ◽  
Labor Costs ◽  
For Profit

This exploratory, mixed-methods study analyzes characteristics of the emerging for-profit nursing home industry in the Netherlands and identifies the interrelated set of factors (context, trends, and sector conditions) that contribute to its growth. Until recently, the Dutch nursing home sector relied almost exclusively on nonprofit providers. Even though profit distribution in nursing home care is still banned, the for-profit nursing home sector is expanding. The study uses economic theory on nonprofit organizations and mixed-form markets to understand this expansion. We find that changes in the regulatory framework have unlocked the potential of the for-profit nursing home sector, enabling for-profit nursing homes to circumvent the for-profit ban. The expansion of the for-profit sector was mainly driven by the low responsiveness of the nonprofit sector to increased and changed demands. For-profit providers took advantage of this void. Moreover, they exploited “cream-skimming” potential in the market and used the wider care system to reduce their labor costs by relying on external specialist care. Another main driver was the access to financial capital from private investors (e.g., private equity firms).

Factors Associated With Care Workers’ Intention to Leave Employment in Nursing Homes: A Secondary Data Analysis of the Swiss Nursing Homes Human Resources Project

2017 ◽  
Vol 38 (11) ◽  
pp. 1537-1563 ◽  
Author(s):  
Clergia Gaudenz ◽  
Sabina De Geest ◽  
René Schwendimann ◽  
Franziska Zúñiga
Keyword(s):  
Nursing Home ◽  
Data Analysis ◽  
Nursing Homes ◽  
Secondary Data ◽  
Intention To Leave ◽  
Nursing Home Care ◽  
Affective Organizational Commitment ◽  
Care Workers ◽  
Home Care Workers ◽  
Care Worker

The emerging care personnel shortage in Swiss nursing homes is aggravated by high turnover rates. As intention to leave is a predictor of turnover, awareness of its associated factors is essential. This study applied a secondary data analysis to evaluate the prevalence and variability of 3,984 nursing home care workers’ intention to leave. Work environment factors and care worker outcomes were tested via multiple regression analysis. Although 56% of care workers reported intention to leave, prevalences varied widely between facilities. Overall, intention to leave showed strong inverse relationships with supportive leadership and affective organizational commitment and weaker positive relationships with stress due to workload, emotional exhaustion, and care worker health problems. The strong direct relationship of nursing home care workers’ intention to leave with affective organizational commitment and perceptions of leadership quality suggest that multilevel interventions to improve these factors might reduce intention to leave.

Ownership and Quality in Markets with Asymmetric Information: Evidence from Nursing Homes

2012 ◽  
Vol 12 (1) ◽  
Author(s):  
Avner Ben-Ner ◽  
Pinar Karaca-Mandic ◽  
Ting Ren
Keyword(s):  
Nursing Home ◽  
Local Government ◽  
Asymmetric Information ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Quality Attributes ◽  
For Profit ◽  
Different Types

Abstract The ownership and governance of for-profit (FP), nonprofit (NP), and local government (LG) organizations are different. Therefore, the objectives of these different types of organizations and their performance may differ. We conjecture that in markets where there is substantial asymmetric information between providers and customers, FP firms, LG organizations and NP organizations provide similar levels of quality attributes that are observable to their customers and are well understood by them. However, FP firms are likely to provide lower levels of less-well observed and less-well understood desirable but costly quality attributes than their NP and LG counterparts. Using a rich dataset, we study the quality of outcomes for Minnesota nursing homes, which do not compete on prices. We find support for our theoretical conjectures: FP homes provide lower quality on a number of dimensions, especially those that are less observable by nursing home residents and their families.

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