The Role of Assisted Living Capacity on Nursing Home Financial Performance

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.

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

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958018787995 ◽

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.

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Nursing home prices and market structure: the effect of assisted living industry expansion

Health Economics Policy and Law ◽

10.1017/s174413311300025x ◽

2013 ◽

Vol 9 (1) ◽

pp. 95-112 ◽

Cited By ~ 9

Author(s):

John R. Bowblis

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Home Care ◽

Market Structure ◽

Assisted Living ◽

Nursing Home Care ◽

Assisted Living Facilities ◽

Home Market ◽

Home Prices ◽

The Relationship

AbstractSince the 1990s, there has been substantial expansion of facility-based alternatives to nursing home care, such as assisted living facilities. This paper analyzes the relationship between expansion of the assisted living industry, nursing home market structure and nursing home private pay prices using a two-year panel of nursing homes in the State of Ohio. Fixed effect regressions suggest that the expansion of assisted living facilities are associated with increased nursing home concentration, but find no effect on private pay nursing home prices. This would be consistent with assisted livings reducing demand for nursing homes by delaying entry into a nursing home, though assisted livings are not direct competitors of nursing homes.

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Job Resignation in Nursing Homes During the COVID-19 Pandemic: The Role of Quality of Employer Communication

Journal of Applied Gerontology ◽

10.1177/07334648211040509 ◽

2021 ◽

pp. 073346482110405

Author(s):

Verena R. Cimarolli ◽

Natasha S. Bryant ◽

Francesca Falzarano ◽

Robyn Stone

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Organizational Factors ◽

Work Stressors ◽

Path Analyses ◽

The Relationship

Limited research has examined coronavirus disease 2019 (COVID-19)-related work stressors experienced by nursing home (NH) employees and how these stressors may impact employees’ decision to resign when taking organizational factors into account. Thus, the purpose of this study was to investigate whether quality of employer communication related to COVID-19 and staff preparedness to care for residents with COVID-19 can mediate the effects of COVID-19-related stressors on NH employees’ ( N = 1,730) decision to resign. Results from path analyses indicate that higher quality of communication and more optimal preparedness mediated the relationship between COVID-19-related stressors and likelihood of resignation. Specifically, higher levels of COVID-19-related stressors were indirectly associated with reduced likelihood of resigning through the paths of more optimal communication and preparedness. Findings underscore the importance of effective employer communication during emergencies in NHs.

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Faith and End of Life in Nursing Homes

Journal of Aging Research ◽

10.4061/2011/390427 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Robert L. Rubinstein ◽

Helen K. Black ◽

Patrick J. Doyle ◽

Miriam Moss ◽

Sidney Z. Moss

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Belief Systems ◽

Death And Dying ◽

Term Care ◽

Catholic Faith ◽

Belief In God ◽

The Relationship

This paper explores the role of religious belief in the experiences of dying and death in a Catholic nursing home. The home appeals to residents and their families due to the active religious presence. Thus, religion is a salient element of the “local culture” which exists in this long-term care setting. The preeminence of faith within the organization and the personal religious convictions of staff, residents, and families may drive how death and dying are discussed and experienced in this setting, as well as the meanings that are attached to them. This paper examines the relationship between faith and the experience and meaning of death in this nursing home. We present themes that emerged from open-ended interviews with residents, family members, and staff, gathered between 1996 and 2004. The data indicate that people select the home due to their Catholic faith and the home's religious tone. Themes also show that belief in God and an afterlife helps shape the experience of dying and death for our informants. Our paper does not compare ease of dying with other nursing homes or within other belief systems.

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

Innovation in Aging ◽

10.1093/geroni/igz038.560 ◽

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.

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Role of resource slack in rapid international expansion of restaurant companies

International Journal of Contemporary Hospitality Management ◽

10.1108/ijchm-07-2017-0415 ◽

2019 ◽

Vol 31 (1) ◽

pp. 2-20

Author(s):

Yue Vaughan ◽

Yoon Koh

Keyword(s):

Firm Value ◽

Fixed Effects ◽

Firm Growth ◽

Negative Impact ◽

Hierarchical Regression ◽

International Expansion ◽

Slack Resources ◽

Content Type ◽

The Relationship

PurposeThe purpose of this study is to investigate the relationship between rapid internationalization and firm value in US restaurant companies. This study also identified the moderating role of available slack, potential slack and recoverable slack on the relationship of rapid internationalization and the firm’s value.Design/methodology/approachA hierarchical regression analysis with panel fixed effects was used in this study. Samples were drawn from publicly traded US restaurant companies, and span from 1993 to 2016 with 264 firm-year observations was used for the study’s analysis.FindingsDrawing on Penrose’s seminal theory of firm-growth that a firm needs excess resources to grow and that the amount of slack resources directly influences a firm’s international growth, this study found that available slack alleviates the negative impact of rapid international expansion in achieving higher firm value.Originality/valueThis study is one of the few analyses that examined thespeedof rapid international expansion in the service context. In addition, this study contributes to existing literature by examining three different slack resources with regards to the speed of international expansion. The findings of this study shed light on restaurant companies whose financial resources are critical for value-adding international expansion.

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

Innovation in Aging ◽

10.1093/geroni/igaa057.2363 ◽

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.

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Which Relationship between Gender Diversity, Intellectual Capital and Financial Performance?

International Journal of Business and Management ◽

10.5539/ijbm.v14n10p101 ◽

2019 ◽

Vol 14 (10) ◽

pp. 101

Author(s):

Marco Giuliani ◽

Simone Poli

Keyword(s):

Financial Performance ◽

Board Of Directors ◽

Intellectual Capital ◽

Negative Impact ◽

Gender Diversity ◽

Multiple Regression Model ◽

Mediating Effect ◽

Systemic Analysis ◽

The Relationship

Some would argue that gender diversity, both in ownership and in board of directors, can affect both financial performance and intellectual capital (IC) performance, and that the latter, in turn, can affect financial performance. This leads to hypothesise that IC performance can be a mediator in the relationship between gender diversity, in ownership or board of directors, and financial performance. As this hypothesis does not appear to have had an adequate investigation in literature, this paper aims to investigate if IC performance can be considered as a mediator in the relationship between gender diversity and financial performance. The test of this hypothesis is performed applying the multiple regression model suggested by Baron and Kenny (1986) to a sample of Italian small and medium-sized enterprises (SMEs). The study shows that gender diversity in ownership negatively impacts on financial performance, directly and indirectly, and that gender diversity in board of directors negatively impacts on financial performance, only indirectly. The indirect effects are due to the negative impact of gender diversity, both in ownership and in board of directors, on IC performance. IC performance plays the role of mediator in the relationship between gender diversity and financial performance. The mediating effect is partial regarding gender diversity in ownership. It is perfect concerning gender diversity in board of directors. This study contributes to the extant literature about the relationships between gender diversity, IC performance and financial performance by offering a systemic analysis of these three items that tend to be investigated separately.

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

Innovation in Aging ◽

10.1093/geroni/igz038.2570 ◽

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.

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