Administrators and Quality of Care in Long-Term Care Facilities

An Examination of Assisted Living Facility Administrator Qualifications Across States

Resident acuity, Medicaid's increased role in funding assisted living, and the COVID-19 pandemic have brought increased attention to the regulatory environment of assisted living facilities (ALFs) and the responsibilities of ALF administrators (ALFAs) are growing increasingly complex. This study explores, describes, and compares the education (degree and assisted living-specific training), experience, exam (competency), and continuing education requirements for ALFAs across all states, and how states' requirements compare to national assisted living associations' suggested standards for entry-level and ongoing practice. Wide variation in ALFA qualifications are identified, with some states found to have extremely low qualification requirements.

Factors Related to Healthcare Service Quality in Long-term Care Hospitals in South Korea: A Mixed-methods Study

Objectives

The environment of long-term care hospitals (LTCHs) is critical to the management of the quality of their services and to patient safety, as highlighted by international studies. However, there is a lack of evidence on this topic in South Korea. This study aimed to examine the factors affecting healthcare quality in LTCHs and to explore the effectiveness of their quality management.

Methods

This study used a mixed methods approach with quantitative data collected in a national survey and qualitative data from semi-structured interviews with practice-based managers. The samples included 725 nationally representative LTCHs in South Korea for the quantitative analysis and 15 administrators for the in-depth interviews.

Results

A higher installation rate of patient-safety and hygiene-related facilities and staff with longer-tenures, especially nurses, were more likely to have better healthcare quality and education for both employees and patients.

Conclusion

The need for patient-safety- and hygiene-related facilities in LTCHs that serve older adults reflects their vulnerability to certain adverse events (e.g., infections). Consistent and skillful nursing care to improve the quality of LTCHs can be achieved by developing relevant educational programs for staff and patients, thereby strengthening the relationships between them.

Staffing in Ontario's Long-Term Care Homes: Differences by Profit Status and Chain Ownership

Ontario has the highest proportion of for-profit nursing homes in Canada. These facilities, which are known in Ontario as long-term care (LTC) homes, offer 24-hour custodial as well as nursing care to individuals who cannot live independently. Increasingly, they are also operating as members of multi-facility chains. Using longitudinal data (1996-2011) from the Residential Care Facilities Survey (n = 627), our analysis revealed discernible differences in staffing levels by profit status and chain affiliation. We found for-profit LTC homes - especially those owned by a chain organization - provided significantly fewer hours of care, after adjusting for variation in the residents' care needs. Findings from this study offer new information on the impact of organizational structure on staffing levels in Ontario's LTC homes and have implications for other jurisdictions where a growing presence of private, chain-affiliated operators has been observed.

Beyond the 'iron lungs of gerontology': using evidence to shape the future of nursing homes in Canada

Institutionalization of the Elderly in Canada suggested that efforts to address the underlying causes of age-related declines in health might negate the need for nursing homes. However, the prevalence of chronic disease has increased, and conditions like dementia mean that nursing homes are likely to remain important features of the Canadian health care system. A fundamental problem limiting the ability to understand how nursing homes may change to better meet the needs of an aging population was the lack of person-level clinical information. The introduction of interRAI assessment instruments to most Canadian provinces/territories and the establishment of the national Continuing Care Reporting System represent important steps in our capacity to understand nursing home care in Canada. Evidence from eight provinces and territories shows that the needs of persons in long-term care are highly complex, resource allocations do not always correspond to needs, and quality varies substantially between and within provinces.

Relationship of the Job Tenure of Nursing Home Top Management to the Prevalence of Pressure Ulcers, Pain, and Physical Restraint Use

The association of job tenure among nursing home administrators (NHAs) and directors of nursing (DONs) with the prevalence of pressure ulcers, pain, and physical restraint use was examined. Data sources included the 2004 National Nursing Home Survey and quality measures from the Centers for Medicare and Medicaid Services. Regression models examined NHA tenure ( n = 787) and DON tenure ( n = 703). Control variables included prior prevalence of the respective outcome, NHA/DON education, and facility characteristics among others. Increasing NHA and DON tenure were both associated with decreases in the prevalence of pressure ulcers and pain but not restraint use. DON tenure had more impact on outcomes in earlier stages of tenure than NHA tenure. Effects of NHA tenure were in later stages of tenure. Increasing tenure among NHAs and DONs may influence better resident outcomes within their facility.