The Relationship Between Leadership Styles, Job Satisfaction, and Tenure Among Nursing Home Administrators

Long-term care is considered a subset of health care administration as the characteristics and leadership skills needed differ from other areas of health care. Leadership style directly relates to organizational development, success, and effectiveness. For study purposes, specific focus was placed upon determining the degree to which nursing home administrators (NHAs) perceived styles of leadership determined job satisfaction with tenure as an NHA. Perceptions of leadership style and levels of job satisfaction were determined using a non-experimental, quantitative design, specifically employing a survey research approach. The research instrument in this study, the MLQ, provided the data essential to addressing the research questions and accompanying hypotheses. The effect of study participant response to items on the MLQ associated with the research questions was assessed using univariate analysis of descriptive factors and inferential statistical techniques for statistical significance testing purposes. A total of 87% of study participants indicated that they perceived their leadership style as Nursing Home Administrators (NHA’s) was reflective of Transformational Leadership. However, findings indicated that participants who had a Transactional Leadership style were more likely than other types of leadership styles to select an NHA as a career path if given the opportunity to choose this line of work in the future.

Exploring the Role of Contextual Factors in Medicaid Nursing Homes' Performance: A Qualitative Perspective

This study explored the role of tested contextual factors (structural, market, and management) in high Medicaid (under resourced) nursing homes performance. Four nursing homes in geographically diverse states were purposefully selected for site visits based on high and low performance (quality/ profitability) indicators. Eight nursing home administrators and directors of nursing, and twenty-one nursing staff (RNs, LPNs, and CNAs) and providers of support services were interviewed. Data were analyzed using an inductive thematic approach with NVivo 12 Plus. Within and across case analysis was used to compare participants’ perspectives across nursing homes and across administrators and staff. Several themes provide insight into varied influences of contextual factors on these nursing homes’ performance: focus on quality care, team-based approach, community support and engagement, and staffing retention. Providing quality care to residents was strategic priority in all facilities, which was enhanced by an adopted team-based leadership approach, open-door policy and home-like atmosphere. Community reputation and availability of local training opportunities for CNAs affected nursing staffing which some facilities addressed using creative retention strategies. These research findings will facilitate interventions, such as leadership training and organizational development activities, aimed at improving the performance of low performing facilities in terms of lower costs and better quality.

Nursing home evacuations due to disasters in the United States over 22.5 years from 1995 to 2017

A large and growing segment of the United States population resides in nursing homes. Many nursing home residents have multiple comorbidities, are unable to perform activities of daily living, and need assistance for their daily functioning. They are some of the most fragile and vulnerable members of the population. Disasters are increasing in frequency and severity. This makes it likely that disasters will strike nursing homes and affect their residents. The purpose of this study was to evaluate the characteristics of disasters in the United States that resulted in nursing home evacuations. There were 51 reported nursing home evacuations due to a disaster over 22.5 years between 1995 and 2017. Natural disasters were responsible for the majority of evacuations (58.8 percent) followed by man-made unintentional disasters (37.3 percent) and man-made intentional (arson) (3.9 percent). The single most common reason for evacuation was hurricanes (23.5 percent, N = 12) and internal fires (23.5 percent, N = 12). Water-related disasters accounted for nearly three-fourths of the natural disasters (hurricanes 40 percent, N = 12; floods, 33.3 percent, N = 10; total 73.3 percent, N = 22), then snow/ice storms (13.3 percent, N = 4). Of man-made disasters, over two-thirds (66.7 percent) were due to internal fires (internal fires, n = 12, 57.1 percent and arson n = 2, 9.5 percent; total N = 14, 66.7 percent). The highest number of evacuations occurred in Texas, Louisiana, Missouri, New York, and Pennsylvania. This knowledge should enable nursing home administrators, disaster planners, public health officials, and others to improve preparedness for disasters that lead to nursing home evacuations.

Measuring Caregiver Retention in Nursing Homes

Background and Objectives Retention of nursing home caregivers is examined. This represents the concept of continuously employing the same caregivers in the same facility for a defined period of time. In this research, several measures of caregiver retention are examined and the utility of these measures for practitioners and policy makers is discussed. Research Design and Methods A survey of nursing home administrators conducted in 2016 was used to collect staffing data from 2,898 facilities. This was matched with Nursing Home Compare and the Certification and Survey Provider Enhanced Reporting data. The association of four measures of retention for each of three of types of caregivers with six quality indicators was examined. Results The descriptive statistics show rates of retention at five-years for Nurse Aides [NAs], Registered Nurses [RNs], and Licensed Practical Nurses [LPNs] to be low. The regression estimates show some support for the relationship that high caregiver retention is associated with better overall quality. The relationship was strongest for NAs and RNs. Support was also found for the notion that different measures of retention were more/less associated with quality. The three- and five-year retention measures had the strongest associations with the quality indicators. Discussion and Implications The findings presented provide some evidence that caregiver retention may be an important metric that can be used as a means of improving quality of care in nursing homes. However, the findings also show practitioners and policy makers should be more nuanced in the use of caregiver retention metrics.

Challenges to Admitting Residents: Perspectives from Rural Nursing Home Administrators and Staff

Rural residents are older, on average, than urban residents, with more underlying health conditions and higher rates of disability. Rural nursing homes face unique challenges admitting medically-complex patients and meeting their needs throughout their stay. These challenges may be amplified for certain health conditions. Greater geographic distances also strain transitional care coordination practices with health system referral hubs in urban areas. In this study, we assess perceptions of difficulty rural nursing homes encounter in admitting and serving individuals with dementia, obesity, mental and behavioral health conditions, and medically complex conditions. Using a survey of nursing home administrators located in non-metropolitan counties across the U.S. (n = 209), we assessed the self-reported degree of difficulty identified in serving each of the 4 type of conditions, coupled with qualitative analysis of open-ended questions identifying specific challenges. Rural nursing homes have capacity constraints owing to lower population density, limited financial resources, and unique challenges recruiting and retaining workforce to rural areas. Nursing home administrators reported the most challenges to providing high-quality care to residents with mental and behavioral health challenges, followed by obesity. For specific challenges, administrators focused primarily on staffing concerns, as well as space and equipment needs. Rural nursing home administrators identified challenges related to specific conditions and capacity constraints. To ensure appropriate and high-quality nursing home placement for rural residents, and to minimize the disruption of transitions into nursing home settings, more attention is needed on addressing the constraints identified by rural nursing home administrators in this study.

Qualitative Assessment of Resident Obesity in Nursing Homes by Medical Providers

We present qualitative themes from an ongoing five-year AHRQ-funded project (R01HS026943) examining the various ways nursing homes provide care for residents with obesity to determine the most effective way to prevent adverse safety events for residents with obesity. Obesity is a common diagnosis among short- and long-stay residents, and in the past, nursing home administrators have reported concerns from admissions issues to negative resident outcomes. No studies have examined the medical provider’s perspective on health of residents with obesity. In this abstract, we present three emergent themes from semi-structured interviews of medical providers (n=6) (nursing home medical directors, staff physicians, nurse practitioners) across the U.S. First, residents with obesity often have several complex and challenging medical conditions that require more services and health monitoring than most residents. Significant medical issues include diabetes, hypertension, cardiovascular disease, arthritis, and sleep apnea. Second, medical providers observe that it is difficult to provide daily custodial and nursing care, but the actual medical harm from substandard care is hard to quantify. Third, medical providers would like to help residents with obesity to lose weight and live healthier lives. There is, however, not an easy way to facilitate weight loss, due to limited resident physical activity, concerns about unhealthy weight loss, and difficulty changing established dietary habits of residents. These findings are limited by sample size, though themes have been consistent within the current participants. Comparing and contrasting these themes with other stakeholder groups (residents, nurse aides, administrators) interviews in the future will strengthen these findings.

Covid-19 Swept Nursing Homes in the United States

Nursing Homes experienced a colossal loss impacted by the Covid-19 pandemic in the United States. This study applied Covid-19 Nursing Home Dataset (updated on 08/16/2020) released by Data.CMS.gov to explore possible factors behind the death s at nursing homes. The results indicated 2.55 residents died per week at a nursing home averagely. Besides, the absence of nursing staff, aides, clinical physicians, PPE supplies contributes to more deaths at nursing homes. Lastly, the number of positive COVID-19 cases of nursing home staff positively associate with the number of total deaths of residents（R=0.65). These findings provide more pieces of evidence for nursing home administrators and policymakers to make adjustments to help nursing home residents better cope with challenges caused by the pandemic; however, this dataset is not the final data for the pandmic is not over. Also, the dataset covers few demographic information (gender, race, ethinicty and so on) ; therefore, researchers could explore the relationship between the demographic features and COVID-19 deaths at nursing homes.

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 US nursing homes. Research Design and Methods We conducted searches of five databases, yielding 3,479 records; screening/review yielded 88 unique records analyzed using Donabedian’s structure-process-outcome model (Donabedian, 2003) as an organizing framework. 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.

Characterizing Physician Practice in Nursing Homes Using Claims-Based Measures: Correlation With Nursing Home Administrators’ Perceptions

Heterogeneity in physician practice within nursing homes (NHs) may explain variations in quality. However, data on physician practice organization in NHs are hard to obtain. We characterized NH physician practice using two claims-based measures: (a) concentration of NH care among physicians (measured by Herfindahl–Hirschman index of visits); and (b) physician NH practice specialization (measured by the proportion of a physician’s visits to NHs). We examined the relationship between the measures and NH administrator perceptions of physician practice reported in the Shaping Long-Term Care in America (SLTCA) Survey. All 2011 Part B claims from 13,718 physicians who treated Medicare fee-for-service patients in 2,095 NHs in the SLTCA survey were analyzed. The median Herfindahl–Hirschman index was 0.44 (interquartile range [IQR] 0.28-0.70), and the median specialization was 38.1% (IQR 19.9% to 60.9%). NHs with higher physician specialization reported more frequent physician participation in care coordination activities. Claims-based measures could inform the study of NH physician practice.

EVACUATING OR SHELTERING IN PLACE DURING A DISASTER: HOW ASSISTED LIVING ADMINISTRATORS MAKE THE DECISION

The decision to evacuate or shelter in place during a natural disaster such as a hurricane is complicated and poses risks to long-term care residents. While research has documented the difficulty of the evacuation decision for nursing home administrators, little is known about how assisted living residence (ALR) administrators make this decision. This is a concern given the physical and cognitive impairment level of many ALR residents, the increasing number of ALRs in the U.S., and the frequency of natural disasters. The purpose of this paper was to explore the factors that influenced whether assisted living administrators evacuated their ALRs for Hurricane Irma, a large hurricane that made landfall on Florida’s Southwest coast in September, 2017. This qualitative study used semi-structured interviews and focus groups with ALR owners or administrative staff (N=60) with questions including how they prepared for Hurricane Irma, their experiences during the hurricane, including whether they evacuated or sheltered in place, and lessons learned. The sample includes small (< 25 beds) and large ALRs in the multiple Florida counties affected by the hurricane. A content analysis approach was used. Atlas.ti version 7 was used for initial and axial coding. Prevalent themes included “emergency management planning”, “logistics”, “pressure”, “storm characteristics,” and “staffing”. The results of this study have implications for long-term care policy and training, potentially leading to changes in how ALR leaders prepare for and respond to disasters to improve the safety of residents.