Nursing Home Quality and Management Survey in the State of Indiana

Document Type


Presentation Date

Summer 6-30-2014

Conference Name

Public Management Research Conference

Conference Location

Seoul. South Korea.

Peer Review



With aging society the quality concern on nursing homes has been increasing. To improve nursing home quality, the government does various regulations on the market including regular inspections, staffing guidelines, and the like. The reporting system and open market information like the Nursing Home Compare (NHC) are believed to reduce information asymmetry between the facility and potential residents, consequently improving quality. This study surveyed 515 nursing home administrators of Indiana Medicare and Medicaid certified facilities regarding their self-evaluation on the structure, process, and outcomes of their facilities following the Donebedian Model. The mailing and online surveys were distributed and the data were collected between August to December of 2013. First, facilities characteristics were discussed using descriptive statistics and the gap between the survey outcomes and the NHC data were discussed. Second, the combined data of the survey and the NHC were analyzed using ordered logistic regression analysis to find out what contributes to nursing homes’ overall performance. The results told us that for-profit and government owned nursing facilities have a greater probability to be in much above average overall performance compared to for-profits. Facilities with higher RN staffing out of the total licensed staffing hours and with higher CNA hours had a greater probability of being much above average overall rating. More visitors increased the probability as well. As a solution to enhance the quality, 43 percent agreed that states need to set their own standard of staffing guidelines While 55 percent disagreed. Nursing administrators emphasized that staffing standards without considering acuity levels, size, and location are meaningless. At the same time, they stressed that the organization’s mission, philosophy, and the culture is important for the quality because quality of care is top-down efforts. Further studies are guaranteed for deeper understanding on organizational and management differences between non-profits and for-profit nursing home and its connection to the quality.


nursing home performance, management


Public Affairs, Public Policy and Public Administration

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