Administrator Turnover and Quality of Care in Nursing Homes

PURPOSE OF THE STUDY: In this article, the author examine the association between turnover of nursing home administrators and five important quality of care outcomes. DESIGN AND METHODS: The data came from a survey of 420 nursing facilities and the 1999 On-line Survey, Certification, and Reporting System. Using multivariate logistic regression analyses, the author looked at the effects of turnover of administrators in nursing homes belonging to chain organizations and in nursing homes not belonging to chain organizations. RESULTS: The author found the average annual turnover rate of administrators to be 43%. The multivariate logistic regression analyses show that in nursing homes belonging to chains, administrator turnover is associated with a higher than average proportion of residents who were catheterized, had pressure ulcers, and were given psychoactive drugs and with a higher than average number of quality-of-care deficiencies. In nursing homes not belonging to chains the author found that turnover of administrators is associated with a higher than average proportion of residents who were restrained, were catheterized, had pressure ulcers, and were given psychoactive drugs. IMPLICATIONS: There is a need to improve understanding of how and why better outcomes are achieved in some nursing homes. This investigation serves to focus attention on nursing home administrators. The author believe this study provides preliminary evidence that the turnover of administrators may have an important association with quality of care in nursing homes.