The Influence of Nursing Home Administrator Turnover on Resident Quality of Life

By 2040, 79.7 million older adults will live in the US, and nearly 40% will need nursing home services that are primarily funded by Medicare and Medicaid. Researchers have underscored the importance of leadership in quality healthcare care delivery, suggesting that nursing home administrator turnover could influence resident quality of life, causing ill-health for the residents and preventable medical costs for taxpayers. In spite of the suggested association, little research has specifically examined the role of administrator turnover on resident quality of life. As such, the purpose and central research questions of this case study were designed specifically to address the relationship between nursing home administrator turnover and resident quality of life. The Donabedian health services quality model was the framework for the study. Data were collected from 14 nursing homes, and included semistructured interview data with 7 nursing home administrators, and a review of other documents related to quality of care including site visit reports and surveys. An iterative process of coding and constant comparison was used to identify themes and categories from the data. The findings indicate that turnover likely caused an adverse impact on the nursing home overall, which was expected. The study also determined, however, that high turnover itself was not perceived to be associated to low resident quality of life. The implication for social change is that nursing home stakeholders may develop processes to retain competent administrators which in turn could reduce absent leadership presence in nursing homes. Consistent leadership presence may lead to improvement in quality of life regulatory compliance and reduction in unnecessary Medicare and Medicaid spending by nursing home residents. The Influence of Nursing Home Administrator Turnover on Resident Quality of Life by Juliet Iheomakanwa Madubata MBA, University of the District of Columbia, 1992 BSc. , Southern University in New Orleans, 1986 BSN, Chamberlain College of Nursing, 2009 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Policy and Administration Walden University March 2015 Dedication This research is dedicated to my family. To my dad Rowland Eke Mbajunwa, who was a Retired Police Inspector. Thank you for telling me that the sky was my limit. This degree is for you. I wish you were here today to cheer me on in life. To my husband wonderful Dr. Christian D. Madubata and my seven great children Chiduzie, Nnaemeka, Ugochi, Chioma, Chinwe, Ijeoma, and Chukwunyere, you are my rock. Thank you for your love, patience, guidance and sustenance throughout this process. To my mom Dorathy Ihuarula Mbajunwa, thank you for everything. To my brothers Henry, Stanley, Martin, Noel, Lawson, and Franklin, and my sisters Edna and Adline, thank you for your unshakeable belief in me. Thank you for your support and being my cheerleaders. To my Nigerian, American and Walden extended family thank you for your support. Acknowledgments First and foremost I would like to thank the Almighty God for his guidance and protection during this journey. To my dad Rowland Eke Mbajunwa, thank you for teaching me the value of education. I did not forget to go for my dreams. This dissertation could not have been possible without the continuing patience, guidance and support of my committee members. To Dr. Gema Hernandez my Chair, thank you very much for your unceasing trust, patience, support and guidance. I do not think that the completion of this research would have been possible without your ongoing presence and involvement. You are a diamond. I hope to follow your footsteps. To Dr. James Goes and Dr. Christina Spoons my Methodology Experts, thank you very much for your constructive feedback, advice and support. Without you, I wouldn’t have understood the difference between limitations and delimitations. Your wealth of research expertise enables you to send us to the right direction at all the time. Thank you Dr. Patricia Ripoll my URR for your continuous support and guidance during this process. To all the NHAs who assisted me with my quest for knowledge, I salute you. I know that you are very busy, and your job is hard. I cannot thank you enough for what you do every day. Thank you for taking care of the older adults of America. To all the employees of Maryland Health and Mental Hygiene, who assisted me with data access and retrieval, I thank you.