scholarly journals THE IMPACT OF CULTURE CHANGE ON FINANCIAL PERFORMANCE OF HIGH MEDICAID NURSING HOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S156-S156
Author(s):  
Justin C Lord ◽  
Ganisher K Davlyatov ◽  
Akbar Ghiasi ◽  
Robert Weech-Maldonado
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Financial Performance ◽  
Culture Change ◽  
Market Competition ◽  
Profit Margin ◽  
Organizational Level ◽  
Poverty Level ◽  
The Impact ◽  
The Relationship

Abstract This study examines the association between culture change artifacts and financial performance among under-resourced nursing homes (70% or higher Medicaid census). Culture change represents a transformational process to become person-centered, through staff and resident empowerment. Cultural artifacts represent the physical evidences that culture change is occurring. In this study, we focus on the workplace (nurse staffing consistent assignments) and leadership (residents engagement) artifacts to assess the relationship between culture change practices and performance. Survey data came from 387 nursing home directors from 2016- 2018, merged with secondary data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. The dependent variable consisted of the total profit margin (%), while the independent variables comprised composite scores for leadership (0-25) and workplace artifacts (0-15). Control variables included organizational-level (ownership, chain affiliation, size, occupancy rate, and Medicare and Medicaid payer mix), and county-level factors (Medicare Advantage penetration, per capita income, educational level, unemployment rate, poverty level and competition). Multivariate regression was used to model the relationship between cultural change artifacts and financial performance. Workplace artifacts in nursing homes were found to be associated with significantly higher profit margin (β = 0.30, p < 0.05), while leadership artifacts were not. Culture change practices aimed at improving nursing staff consistent assignments are associated with better financial performance. Given increasing nursing home market competition and declining resources for high Medicaid nursing homes, facilities with a greater emphasis on workplace culture may be able to perform better financially among these under-resourced facilities.

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.

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

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 679-679
Author(s):  
Justin Lord ◽  
Akbar Ghiasi ◽  
Ganisher Davlyatov ◽  
Robert Weech-Maldonado
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Financial Performance ◽  
Leadership Styles ◽  
Secondary Data ◽  
Trade Offs ◽  
Autocratic Leadership ◽  
Resource File ◽  
Composite Scores ◽  
The Impact

Abstract This study examined the association between leadership styles (autocrat, consultative autocrat, consensus manager, and shareholder manager) and resident quality and financial performance in under-resourced nursing homes. Survey data from 391 Directors of Nursing were merged with secondary data from LTCFocus, Area Health Resource File, Medicare Cost Reports, and Nursing Home Compare. Two multivariate regressions were used to model the relationship between leadership styles and the dependent variables: nursing home star ratings (1-5) and operating margin. The independent variables were composite scores for leadership styles, while control variables included organizational and county-level factors. Results show that compared to autocratic leadership, the consultative autocrat (solicits feedback but has total authority) was associated with lower quality (p < 0.05), while the consensus manager (delegates authority to the group) was associated with lower profit margin (p < 0.05). Under-resourced facilities need to recognize trade-offs of different decision making styles for performance.

scholarly journals THE RELATIONSHIP BETWEEN ORGANIZATIONAL CULTURE AND FINANCIAL PERFORMANCE AMONG HIGH-MEDICAID NURSING HOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S698-S698
Author(s):  
Robert Weech-Maldonado ◽  
Akbar Ghiasi ◽  
Ganisher K Davlyatov ◽  
Justin C Lord ◽  
Jane Banaszak-Holl
Keyword(s):  
Organizational Culture ◽  
Nursing Home ◽  
Nursing Homes ◽  
Financial Performance ◽  
Working Environment ◽  
Future Research ◽  
Market Culture ◽  
Operating Margin ◽  
Clan Culture ◽  
The Relationship

Abstract This study examines the relationship between organizational culture and financial performance of high Medicaid census (70% or higher) nursing homes (NHs). Based on the Competing Values Framework, there are four types of organizational culture: clan culture (friendly working environment); adhocracy culture (dynamic/creative working environment); market culture (results-based organization); and hierarchy culture (formalized/structured work environment). This study used facility survey data from approximately 324 nursing home administrators (30% response rate) from 2017- 2018, merged with secondary data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. The dependent variable consisted of the operating margin, while the independent variable comprised type of organizational culture. Control variables were organizational (ownership, chain affiliation, size, occupancy rate, and payer mix), and county-level factors (Medicare Advantage penetration, income, education, unemployment rate, poverty, and competition). Multivariable regression was used to model the relationship between organizational culture type and financial performance. Regression results show that compared to a market culture, a hierarchy culture was associated with an 11.8 % lower operating margin, a clan culture with a 10.6% lower operating margin, and a non-dominant culture with 11.4% lower operating margin. Organizational culture is associated with financial performance among high Medicaid facilities, with market cultures outperforming other organizational cultures. Given increasing competition in the nursing home market and declining resources for high Medicaid nursing homes, facilities with a more external orientation and focus on results may be able to perform better financially. Future research should examine the effect of organizational culture on quality of care.

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 The Role of Assisted Living Capacity on Nursing Home Financial Performance

2018 ◽  
Vol 55 ◽  
pp. 004695801879328 ◽  
Author(s):  
Justin Lord ◽  
Ganisher Davlyatov ◽  
Kali S. Thomas ◽  
Kathryn Hyer ◽  
Robert Weech-Maldonado
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Financial Performance ◽  
Assisted Living ◽  
Repeated Measures ◽  
Fixed Effects ◽  
Negative Impact ◽  
Secondary Data ◽  
The Relationship

The rapid growth of the assisted living industry has coincided with decreased levels of nursing home occupancy and financial performance. The purpose of this article is to examine the relationships among assisted living capacity, nursing home occupancy, and nursing home financial performance. In addition, we explore whether the relationship between assisted living capacity and nursing home financial performance is mediated by nursing home occupancy. This research utilized publicly available secondary data, for the state of Florida from 2003 through 2015. General descriptive statistics were used to assess the relationships among financial performance, assisted living capacity, and occupancy. To explore the relationships among financial performance, assisted living capacity and occupancy, and test potential mediation of occupancy, we followed Baron and Kenny’s approach and estimated 3 models examining the relationships between (1) assisted living capacity and nursing home financial performance, (2) assisted living capacity and nursing home occupancy, and (3) nursing home occupancy and financial performance after assisted living capacity is included in the model. We used generalized estimating equations, to adjust for repeated measures and to model the above relationships. Year fixed effects control for time trend. The independent variable, assisted living beds, was lagged for 1 year to account for the potential influence on financial performance. The final analytic sample consisted of 7688 nursing home-year observations from 657 unique nursing homes. Our findings suggest that assisted living capacity does have a negative impact on nursing homes’ financial performance. Even though, assisted living capacity seems not to significantly decrease nursing home occupancy. The relationship between assisted living capacity and financial performance was not mediated through occupancy. These findings suggest that assisted living communities may not be able to significantly reduce nursing home occupancy; however, the presence of assisted living communities may create additional financial/competitive pressures that result in decreased nursing home financial performance.

scholarly journals Exploring Leadership, Stress of Conscience, and Person-Centered Care in Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 181-182
Author(s):  
Annica Backman ◽  
Karin Sjögren ◽  
Hugo Lovheim ◽  
Marie Lindkvist ◽  
David Edvardsson
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Daily Basis ◽  
Care Providers ◽  
Cross Sectional ◽  
Negatively Associated ◽  
Centered Care ◽  
Stress Of Conscience ◽  
The Impact ◽  
The Relationship

Abstract On a daily basis, many care situations contain difficult issues and challenges for care providers. Stress of conscience, such as feelings of guilt, can be experienced by staff when not fulfilling ethical obligations to the residents. Although leadership has been advocated as a key component for staff work perceptions as well as for person-centred care, the impact of nursing home managers’ leadership on levels of stress of conscience among staff and the extent to which person-centred care (PCC) is provided is yet to be explored. Thus, the aim was to explore the relationship between leadership, stress of conscience and PCC as perceived by staff. The study was based on a cross-sectional national survey of 3084 staff and their managers in 189 nursing homes throughout Sweden. Descriptive statistics and regression modelling were used to explore associations. The preliminary results showed that leadership was negatively associated to stress of conscience and positively associated to PCC. PCC were negatively associated to stress of conscience. Additional findings will be presented. This indicates that nursing home managers’ leadership seem to beneficially impact staff work situation in terms of stress of conscience and person-centred care provision.

A Preliminary Test of the Impact of De-Globalization on MNC Performance

2021 ◽  
Vol 17 (2) ◽  
pp. 412-428
Author(s):  
Hilla Peretz ◽  
Michael J. Morley
Keyword(s):  
Organizational Context ◽  
Preliminary Test ◽  
Organizational Level ◽  
Institutional Fit ◽  
Preliminary Examination ◽  
Negative Effect ◽  
Key Dimensions ◽  
Using Data ◽  
The Impact ◽  
The Relationship

ABSTRACTWe offer a preliminary examination of whether national and organizational level contexts amplify or reduce the effects of de-globalization on the performance of MNCs. Theoretically, we borrow ideas from both event system theory and institutional fit to propose a model explicating key dimensions of the relationship between de-globalization, national and organizational context, and MNC performance. We then test our ideas using data assembled from 283 MNCs in 20 countries. We find that while de-globalization has a negative effect on MNC performance, national and organizational level contextual endowments do moderate this relationship. We discuss some implications of our findings and highlight attendant limitations.

scholarly journals Impact of Roommates on MDRO Spread in Nursing Homes

2020 ◽  
Vol 41 (S1) ◽  
pp. s66-s67
Author(s):  
Gabrielle M. Gussin ◽  
Ken Kleinman ◽  
Raveena D. Singh ◽  
Raheeb Saavedra ◽  
Lauren Heim ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Secondary Analysis ◽  
Nursing Home Residents ◽  
Multidrug Resistant ◽  
Healthcare Intervention ◽  
Odds Ratios ◽  
Care Needs ◽  
Environmental Cleaning ◽  
The Impact

Background: Addressing the high burden of multidrug-resistant organisms (MDROs) in nursing homes is a public health priority. High interfacility transmission may be attributed to inadequate infection prevention practices, shared living spaces, and frequent care needs. We assessed the contribution of roommates to the likelihood of MDRO carriage in nursing homes. Methods: We performed a secondary analysis of the SHIELD OC (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, CA) Project, a CDC-funded regional decolonization intervention to reduce MDROs among 38 regional facilities (18 nursing homes, 3 long-term acute-care hospitals, and 17 hospitals). Decolonization in participating nursing homes involved routine chlorhexidine bathing plus nasal iodophor (Monday through Friday, twice daily every other week) from April 2017 through July 2019. MDRO point-prevalence assessments involving all residents at 16 nursing homes conducted at the end of the intervention period were used to determine whether having a roommate was associated with MDRO carriage. Nares, bilateral axilla/groin, and perirectal swabs were processed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). Generalized linear mixed models assessed the impact of maximum room occupancy on MDRO prevalence when clustering by room and hallway, and adjusting for the following factors: nursing home facility, age, gender, length-of-stay at time of swabbing, bedbound status, known MDRO history, and presence of urinary or gastrointestinal devices. CRE models were not run due to low counts. Results: During the intervention phase, 1,451 residents were sampled across 16 nursing homes. Overall MDRO prevalence was 49%. In multivariable models, we detected a significant increasing association of maximum room occupants and MDRO carriage for MRSA but not other MDROs. For MRSA, the adjusted odds ratios for quadruple-, triple-, and double-occupancy rooms were 3.5, 3.6, and 2.8, respectively, compared to residents in single rooms (P = .013). For VRE, these adjusted odds ratios were 0.3, 0.3, and 0.4, respectively, compared to residents in single rooms (P = NS). For ESBL, the adjusted odds ratios were 0.9, 1.1, and 1.5, respectively, compared to residents in single rooms (P = nonsignificant). Conclusions: Nursing home residents in shared rooms were more likely to harbor MRSA, suggesting MRSA transmission between roommates. Although decolonization was previously shown to reduce MDRO prevalence by 22% in SHIELD nursing homes, this strategy did not appear to prevent all MRSA transmission between roommates. Additional efforts involving high adherence hand hygiene, environmental cleaning, and judicious use of contact precautions are likely needed to reduce transmission between roommates in nursing homes.Funding: NoneDisclosures: Gabrielle M. Gussin, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

scholarly journals Analyzing Nursing Home Complaints: From Substantiated Allegation to Deficiency Citations

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 82-83
Author(s):  
Kallol Kumar Bhattacharyya ◽  
Lindsay Peterson ◽  
John Bowblis ◽  
Kathryn Hyer
Keyword(s):  
Nursing Home ◽  
Quality Of Care ◽  
Nursing Homes ◽  
Staff Training ◽  
Policy And Practice ◽  
Abuse And Neglect ◽  
The Relationship ◽  
Investigation Process

Abstract Complaints provide important information to consumers about nursing homes (NHs). Complaints that are substantiated often lead to an investigation and potentially a deficiency citation. The purpose of this study is to understand the relationship between substantiated complaints and deficiency citations. Because a complaint may contain multiple allegations, and the data do not identify which allegation(s) lead to a complaint’s substantiation, we identified all substantiated single allegation complaints for NHs in 2017. Our data were drawn from federally collected NH complaint and inspection records. Among the 369 substantiated single-allegation complaints, we found most were categorized as quality of care (31.7%), resident abuse (17.3%), or resident neglect (14.1%). Of the deficiency citations resulting from complaints in our sample, 27.9% were categorized as quality of care and 19.5% were in the category of resident behavior and facility practices, which includes abuse and neglect. While two-thirds (N=239) of the substantiated complaints generated from 1 to 19 deficiency citations, nearly one third had no citations. Surprisingly, 28% of substantiated abuse and neglect allegations resulted in no deficiency citations. More surprisingly, a fifth of complaints that were categorized as “immediate jeopardy” at intake did not result in any deficiency citations. We also found a number of asymmetries in the allegation categories suggesting different processes by Centers for Medicare and Medicaid Services (CMS) region. These results suggest that the compliant investigation process warrants further investigation. Other policy and practice implications, including the need for better and more uniform investigation processes and staff training, will be discussed.

scholarly journals Culture Change Initiatives in High Medicaid Nursing Homes: Does Time of Adoption Make a Difference?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 22-23
Author(s):  
Latarsha Chisholm ◽  
Akbar Ghiasi ◽  
Justin Lord ◽  
Robert Weech-Maldonado
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Culture Change ◽  
Fixed Effects ◽  
Ethnic Disparities ◽  
State Level ◽  
Change Initiatives ◽  
Term Care ◽  
Star Rating ◽  
Racial Ethnic

Abstract Racial/ethnic disparities have been well documented in long-term care literature. As the population ages and becomes more diverse over time, it is essential to identify mechanisms that may eliminate or mitigate racial/ethnic disparities. Culture change is a movement to transition nursing homes to more home-like environments. The literature on culture change initiatives and quality has been mixed, with little to no literature on the use of culture change initiatives in high Medicaid nursing homes and quality. The purpose of this study was to examine how the involvement of culture change initiatives among high Medicaid facilities was associated with nursing home quality. The study relied on both survey and secondary nursing home data for the years 2017-2018. The sample included high Medicaid (85% or higher) nursing homes. The outcome of interest was the overall nursing home star rating obtained from the Nursing Home Compare Five-Star Quality Rating System. The primary independent variable of interest was the years of involvement in culture change initiatives among nursing homes, which was obtained from the nursing home administrator survey. The final model consisted of an ordinal logistic regression with state-level fixed effects. High-Medicaid nursing homes with six or more years in culture change initiatives had higher odds of having a higher star rating, while facilities with one year or less had significantly lower odds of having a higher star rating. Culture change initiatives may require some time to effectively implement, but these initiatives are potential mechanisms to improve quality in high Medicaid nursing homes.

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