title: Administrator turnover and quality of care in nursing homes.
abstract: OBJECTIVE
  In this article, I examine the association between turnover of nursing home administrators and five important quality of care outcomes.
  
  
  METHODS
  The data came from a survey of 420 nursing facilities and the 1999 On-line Survey, Certification, and Reporting System. Using multivariate logistic regression analyses, I looked at the effects of turnover of administrators in nursing homes belonging to chain organizations and in nursing homes not belonging to chain organizations.
  
  
  RESULTS
  I found the average annual turnover rate of administrators to be 43%. The multivariate logistic regression analyses show that in nursing homes belonging to chains, administrator turnover is associated with a higher than average proportion of residents who were catheterized, had pressure ulcers, and were given psychoactive drugs and with a higher than average number of quality-of-care deficiencies. In nursing homes not belonging to chains I found that turnover of administrators is associated with a higher than average proportion of residents who were restrained, were catheterized, had pressure ulcers, and were given psychoactive drugs.
  
  
  CONCLUSIONS
  There is a need to improve understanding of how and why better outcomes are achieved in some nursing homes. This investigation serves to focus attention on nursing home administrators. I believe this study provides preliminary evidence that the turnover of administrators may have an important association with quality of care in nursing homes.
authors.affiliation: Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA.
authors.forename: N G
authors.initials: NG
authors.lastname: Castle
mesh_terms: D000368:Aged; D019538:Health Care Surveys; D006270:Health Facility Administrators / Q000600:supply & distribution*; D006707:Homes for the Aged / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D016015:Logistic Models; D009096:Multi-Institutional Systems; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000458:organization & administration* / Q000592:standards; D010563:Personnel Turnover; D011787:Quality of Health Care; D014481:United States