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Administrator Turnover and Quality of Care in Nursing Homes

^a Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ

Correspondence: Nicholas G. Castle, PhD, RAND, 201 North Craig Street, Suite 102, Pittsburgh, PA 15213.

Decision Editor: Laurence G. Branch, PhD

Purpose of the Study: In this article, I 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, I looked at the effects of turnover of administrators in nursing homes belonging to chain organi-zations and in nursing homes not belonging to chain organizations. Results: I 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 I 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. I believe this study provides preliminary evidence that the turnover of administrators may have an important association with quality of care in nursing homes.

Key Words: Quality • OSCAR • Administrators

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