The Connection of Social Services to Care Transitions and Discharge Planning in Nursing Home Settings

Care transitions are critical junctures in the healthcare delivery process. Effective transitions and discharge planning reduce the need for subsequent transfers between healthcare settings (Boutwell et al., 2015). Understanding social services (SS) involvement in these processes is important due to its key role in their success (Fabbre et al., 2011). Facility characteristics from 924 nursing homes were evaluated in relation to SS involvement in care transitions and discharge planning. Chi-square tests indicate associations between SS involvement and level of engagement of SS expertise by the nursing home administrator (p=.004), medical director (p=.002), nursing staff (p=.003), community physicians (p=.049), and family members (p<.001). An association between SS involvement and freestanding SS departments was also observed. Results suggest the level of SS involvement in care transitions and discharge planning relates to structural (i.e. SS positioning within the facility) and relational (i.e. perceptions and utilization of SS designees by key facility leadership) factors.

Five-Star Ratings and Managerial Turnover: Evidence from the Nursing Home Industry

The government-sponsored Five-Star Quality Rating System (FSQRS) aggregates multiple measures of nursing home quality into a standardized overall rating. Previous research has found that the FSQRS affected consumer demand and correspondingly motivated a strategic shift toward competing for higher ratings, most notably among nursing homes in more competitive markets. The primary objective of this article is to provide evidence on whether it produced a complementary change in the weight placed on quality ratings in senior management retention decisions. Using the Florida nursing home administrator files from 2007 to 2013, our analysis reveals that the FSQRS motivated a substantial and significant increase in the sensitivity of administrator turnover to star ratings, particularly in more competitive nursing home markets (JEL I18, L15, J63, G24, G34).

TERMINOLOGY USED BY EMPLOYERS AND JOB SEEKERS FOR AGING-RELATED POSITIONS

Our aging society calls for a workforce capable of meeting older adults’ diverse needs. Yet the extent that employers seek out a workforce with aging-related training or education is unclear, as is how people with such backgrounds search for positions. We describe an exploratory content analysis of job postings to understand how employers are searching for applicants with aging-related backgrounds, and compare job posting keywords to terms used by a sample of aging-trained job seekers/employees. Results showed 35% of aging-related job postings used keywords expressing preference for applicants with aging-related backgrounds; the most commonly-occurring terms were “gerontology,” “Assisted living” + “adult day” + “director” + “nursing home administrator,” and “elderly.” Job seekers also cited “gerontology” as a term used to search for positions, along with “aging,” “older adults” and “seniors”. Findings suggest that employers should use more positively-connoted terms to attract applicants with aging-related backgrounds, rather than terms like “elderly.”

NURSING HOME ADMINISTRATOR STRESS, SATISFACTION, AND INTENTIONS TO LEAVE

Previous studies reported that high Nursing Home Administrator (NHA) turnover correlates with low staff morale and poorer care outcomes. The purpose of this study was to assess how NHA job satisfaction (JS) (in five subscales: job content, coworkers, work demands, work load, work skills, and rewards) interacts with role conflict and ambiguity, autonomy, work conflict, and influence and to estimate the odds of having NHA’s intent to quit by degree of job satisfaction. A total 208 responses were collected from the online survey in 2017 among NHAs currently working in nursing homes in 5 states. We analyzed the data using descriptive statistics and ordinal logistic regression models. The findings suggested that NHAs were generally satisfied in all JS subscales and expressed moderately high levels of autonomy, neutral levels of work conflict, role conflict and role ambiguity. NHAs with good coworker relations (adjusted odds ratio [AOR]=0.67), fair job demands (AOR=0.68) and rewards (A0R=0.8), were less likely to harbor quitting intents. Interestingly, NHAs reporting higher job skills were more likely to consider leaving nursing homes (AOR=1.46). Overall, study findings are consistent with previous JS research with the exception that higher perceived skill efficacy was found to be associated with greater likelihood of quitting in the near future. This suggests perhaps that more highly skilled NHAs may now have less tolerance for work discomfort. These findings are presented in the context of earlier studies on NHA turnover as well as likely implications of changing market conditions.