Unraveling the chains: Exploring the impact of ownership on administrator turnover in nursing homes

Background: Leadership instability in nursing homes marked by high administrator turnover threatens the well-being of vulnerable residents. Although numerous factors have been implicated, the role of ownership remains unexplored.

Purposes: Based upon the tenets from institutional theory and strategic management theory, the primary goal of this study was to examine the impact of ownership on administrator turnover.

Methodology/approach: Data were derived from different sources: LTCFocus.org, Nursing Home Five-Star Quality Rating System, and Area Health Resources Files (2021-2022). The dependent variable was administrator turnover categorized as follows: 0 = no administrators left, 1 = one administrator left, and 2 = two or more administrators left. The primary independent variable was ownership/chain affiliation categorized as four possible interactions of for-profit (FP) status and chain affiliation: not-for-profit (NFP) independent, FP independent, NFP chain, and FP chain. An ordinal logistic regression model was used, and predicted turnover probabilities were calculated across the four ownership categories.

Results: The primary hypothesis was supported and compared to NFP independent, FP chain, FP independent, and NFP chain nursing homes that exhibited approximately 2.3, 1.7, and 1.4 times higher odds of administrator turnover. Predicted probabilities confirmed these trends: FP chain nursing homes had the lowest retention, with a 42% probability of no turnover, 32% for one administrator leaving, and 26% for two or more leaving. In contrast, NFP independent facilities had the highest retention rates, with a 62% chance of no turnover, 25% for one leaving, and 13% for two or more. Differences between groups were statistically significant (p < .001).

Conclusion: FP chain ownership was associated with the highest administrator turnover rates, whereas NFP facilities experienced the lowest. FP independent and NFP chain homes had intermediate probabilities of administrator turnover.

Practice implications: Tailoring management strategies to the specific ownership structure may reduce administrator turnover and ensure consistent resident care.