Associations between nursing home leadership turnover and resident satisfaction

The impact of nursing home administrator (NHA) and director of nursing (DON) turnover on residents' care experiences remains underexplored. This study aims to examine the associations of NHA/DON turnover with resident satisfaction scores.

5 data sources were merged to create an aggregate dataset of 752 Ohio nursing homes in 2017: the Ohio Nursing Home Resident Satisfaction Survey, the Ohio Biennial Survey of Long-Term Care Facilities, the Certification and Survey Provider Enhanced Reports, Medicaid Cost Report, and LTCFocus. Resident satisfaction was measured by 8 resident satisfaction scores: the overall satisfaction score and 7 individual domain scores. The scores were continuous variables ranging from 0 (low) to 100 (high). Leadership turnover was assessed using 4 specifications: 1 NHA turnover, 2 or more NHA turnovers, 1 DON turnover, and 2 or more DON turnovers over the past 3 years. Multiple linear regressions were conducted via SAS, adjusting for control variables.

2 or more DON turnovers are associated with a lower overall resident satisfaction score by 1.14% points (p < .05), lower Environment domain score by 1.01% points (p < .05), and lower Caregivers domain score by 1.80% points (p < .01). NHA turnover is not statistically associated with overall resident satisfaction score but positively associated with 2 individual domain scores.

DON turnover is associated with lower resident satisfaction scores, while NHA turnover is not. A single DON turnover may not harm residents' care experiences; however, frequent turnover among DON could negatively impact them.