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nursing homes, quality, top management, turnover



  1. Castle, Nicholas G.
  2. Lin, Michael


Background: Understanding the relationship between top management turnover and quality of care is important because turnover among top managers in nursing homes is generally high.


Purposes: In this research, the direct and indirect relationships among top management turnover, the number of staff, the types of staff, and the quality indicators are examined. The top managers included in this case are both nursing home administrators and directors of nursing.


Methodology/Approach: Primary data were collected from 2,840 nursing homes, and 14 quality indicators came from the Nursing Home Compare. Structural equation modeling methods were used to model direct and indirect relationships.


Findings: The results show that high nursing home administrator turnover for four quality indicators are significantly associated with poor quality. These findings seem to contrast with those for director of nursing turnover, with high director of nursing turnover for three quality indicators significantly associated with better quality.


Practice Implications: We identify three practice implications. First, nursing home administrators may want to be particularly vigilant to resident care in some specific areas associated with poorer quality resulting from turnover. Second, nurse aide agency staff should be used with caution. Third, higher caregiver staffing levels are generally associated with better quality of care.