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The problems of providing high-quality care in nursing homes have been extensively documented. Accounts of residents, close family members, and qualitative researchers have described feelings of desperation, anomie, and hopelessness, which accompany the last years, months and days of those reluctantly finding themselves in institutional facilities at the end of their days. However sociologists have, thus far, paid little attention to the actual and potential impact of families in breaking through the barriers set up by institutional life and in enhancing the responsiveness of care in nursing homes. This chapter aims to fill this gap.

Nursing homes experience high nursing staff turnover. Nursing staff in nursing homes is comprised of gray and blue collar workers that include registered nurses (RNs), licensed practical nurses (LPNs), and certified nurse assistants (CNAs). The relationship between human resource management (HRM)practices, organizational culture, and nursing staff turnover is examined in underresourced (high Medicaid) nursing homes. Survey data from 348 nursing home administrators (NHAs) of USA high Medicaid (85% or higher) facilities were merged with secondary data sources for 2017–2018. The dependent variables (nursing staff turnover rates) consisted of the percentages of RNs, LPNs, and CNAs that had voluntarily quit the organization during the past year. The independent variables were: (1) HRM practices (employee-centered and high involvement practices); and (2) organizational culture: clan, market, hierarchical, and non-dominant. Organizational and market variables were controlled for. Data were modeled using Poisson log-linear regression, and propensity score weights were used to adjust for potential survey non-response bias. Results show high involvement HRM practices and having a clan culture are associated with lower RN, LPN, and CNA staffing turnover. Study findings suggest that organizational culture and HRM practices may be instrumental in reducing nursing turnover in underresourced nursing homes.

The purpose of this paper is to explore the attitudes of nursing home administrators and key managerial staff toward health information technology (health IT).

This research is exploratory in nature, and applies qualitative case-study methodology to further understand health IT adoption by nursing homes through multiple in-depth semi-structured interviews of management, and direct observations of employee behavior at each participating facility. A modified Technology Acceptance Model is used to examine the attitudes and perceptions of administrators.

This study finds that there are differences in the level of health IT adoption by nursing homes. While some administrators are aware of health IT and are implementing or updating their IT systems in a gradual but haphazard manner, others exhibited a lack of interest in implementing change. Overall, there is a lack of systematic planning and decision-making toward health IT adoption. Adoption is not evidence-based, instead driven primarily by real and perceived regulatory requirements combined with a lack of information about, or consideration of, the real costs and benefits of implementing health IT.

Including six in-depth case studies, the sample for this study is small for generalizing the findings. Yet, it contributes to the literature on the slow process of health IT adoption by nursing homes. Moreover, the findings provide guidelines for future research.

This study demonstrates that nursing home administrators must systematically plan the adoption of health IT, and such decision making should be evidenced-based and participatory so that employees can voice their opinions that could prevent future resistance.

This study is original and advances knowledge on the reasons for the slow adoption of health IT in nursing homes. It finds that lack of adequate information regarding the utility and benefits of health IT in management adoption decisions can result in haphazard implementation or no adoption at all. This finding has significant value for policy makers’ practitioners for improving accessibility of information regarding the use of health IT in nursing homes that could address the health IT adoption challenge in this industry.

The purpose of this study is to explore the factors that influence the reporting of adverse events related to elder abuse and neglect in nursing homes from nursing home leaders' perspectives. Good leadership requires in-depth knowledge of the care and service provided and the ability to identify and address problems that can arise in clinical practice.

A qualitative explorative design with data triangulation was used. The sample consisted of 43 participants from two levels of nursing home leadership, representing six municipalities and 21 nursing homes in Norway. Focus group interviews were undertaken with 28 ward leaders and individual interviews with 15 nursing home directors. The constant comparative method was used for the analyses.

Both ward leaders and nursing home directors described formal and informal ways of obtaining information related to elder abuse and neglect. There were differences between their perceptions of the feasibility of obtaining formal reports about abuse in the nursing home. Three main categories of influencing factors emerged: (1) organisation structural factors, (2) cultural factors and (3) abuse severity factors. A main finding is that in its present form, the Norwegian adverse event reporting system is not designed to detect abuse and neglect.

This paper provides an in-depth understanding of patient safety and factors related to reporting elder abuse in nursing homes in Norway.

The purpose of this paper is to investigate the impact of nursing quality on Taiwan nursing homes, and differences of efficiency among different management types of nursing homes.

This study employs data envelopment analysis (DEA) to investigate the efficiency of nursing homes with and without quality variable. The impacts of nursing quality on the efficiency of nursing homes were studied. Finally, Tobit regression is used to explore the factors influencing efficiency in nursing homes.

The analysis shows that nursing quality has significant impacts on operating efficiency of nursing homes. When quality variables are included, all efficiencies were significantly improved, except scale efficiency of government-expense nursing homes (GEH); return of scale status of GEH decrease substantially; the licensed nursing staff can always improve efficiency; higher occupancy rate increase efficiency; private-operated veteran homes performs better than government-operated homes.

Nursing quality has a significant effect on the efficiency measures. Thus, the nursing quality cannot be ignored in assessing the performance of nursing homes. Otherwise, it may result in biased results. The efficiencies of private-operated nursing homes are better than the government operation. Government-operated nursing homes should take private nursing homes as the benchmark.

The paper demonstrates the nursing quality is an important factor in the efficiency measure of nursing homes. It also shows that privatized operation has higher efficiency than the government operation.

Care planning is important in the provision of good‐quality care and serves a variety of functions, including acting as a communication tool. An accessible format for care plans is therefore important. The National Minimum Care Standards in England now require that all residents in care homes have a service user plan. This study examined the format and content of 117 blank care plan documents used in Manchester and Cheshire care homes in 2001/02. Sixty‐eight per cent of homes used a problem‐orientated care plan document, 25% used a problem‐orientated care plan with assessment domains defined, 15% used standard care plans and five per cent used daily care plans. Although the government has stressed the importance of involving the user in the care planning process, only 16% of homes had a care plan that specifically asked for a resident's signature or agreement. There were also differences in content of care plans by home type, which may reflect the professional background and training of staff in nursing homes. The variety in types and format of care plans suggests that the interpretation and recording of care planning may not be uniform across homes and there is a need for further detailed work in this area using interviews or observational approaches.

The aim of this research is to provide insight into how organizations can co-create value with family members engaged in service journeys of customers experiencing vulnerabilities, thereby paying attention to their organizational practices (i.e. recursive or routinized patterns of organizational actions and behaviors).

To investigate, this research relies upon a multiple case study in a group of nursing homes in Flanders that had the ambition to engage family members in service journeys of their loved ones while measuring their value perceptions as a performance indicator (here, satisfaction with nursing home services).

The case evidence shows that nursing homes co-create value with family members through caring practices that focus on their role as secondary customers (i.e. welcoming, connecting and embedding) and empowering practices that focus on their role as partial employees (i.e. teaming up, informing and listening practices). However, the way in which the different caring and empowering practices are enacted by the nursing home and its staff affects their value co-creation potential.

By focusing on the practices with which organizations can co-create value with family members engaged in service journeys of their loved ones, this research bridges the service literature with its attention for value co-creation practices and the literature on customers experiencing vulnerabilities with its focus on extended customer entities.

Older adults living in nursing homes may become vulnerable because of errors or incidents; it is necessary to create a positive safety culture to minimise such occurrences. However, safety culture is still a prevailing issue in Indonesian nursing homes. This study aims to examine factors related to resident safety culture in nursing homes located in Indonesia.

This study used a cross-sectional research design and involved 13 nursing homes in East Java province, Indonesia. Multistage cluster samplings were used to determine the respondents of this study. The respondents included 219 employees: managers, health care, supportive and administrative staff. The Indonesian version of the Safety Attitudes Questionnaire was used to measure safety culture.

Most of the respondents (68.5%) had a positive perspective on the nursing home’s safety culture. Staffs who had worked for six to ten years in the nursing home were 17.07 times more likely to have positive perspective on safety culture with a p-value of 0.0002. Respondents who gave direct care also had a positive perception of safety culture with a p-value of 0.008.

Broader insight into safety culture needs to be provided to all staff in the nursing home. Safety topics should be included in the orientation session for new staff.

The staff’s work experience and direct care have a significant connection to safety culture.

The purpose of this paper is to explore perceptions, perspectives and meaning of quality of life for a sample of older residents, care staff and family caregivers in two nursing homes in Lebanon.

A classic grounded theory study was conducted between 2010 and 2011 in two nursing homes in Beirut. The semi-structured interviews were undertaken with a theoretical sample of 20 residents, 8 family caregivers and 11 staff. The constant comparative method was used to analyze the data.

Three distinct but interrelated properties of quality of life emerged from this process: “maintaining self,” “maintaining identity” and “maintaining continuity”. The dynamics that exist within and between each of these properties provide an indicator about shared and distinct meanings and the implications for care practice.

The study was conducted in one city in Lebanon; accordingly, the transferability of findings may be challenging.

Implications for nursing and nursing policy – improving Lebanese national standards and regulations applicable to nursing home residents may help to enhance residents’ care needs and quality of life.

There was limited guidance aimed at helping older residents to voice and increase their choice and control.

This paper provides new insights into the process of outlining the properties attached to the phenomenon of quality of life in nursing homes in Lebanon. It will be of interest to those in nursing home care as well as to policy makers.

Media reporting is one of many circumstances that nursing homes have to relate to, because of the reputational risks. The aim of this article is to investigate media representations of Swedish nursing homes in relation to reports on an annual national user survey.

The empirical data consist of 381 Swedish newspaper articles about the survey results. The questions guiding the analysis were: what messages on nursing homes are communicated, and how are claims organized in order to appear factual?

The data show that press reports focus on comparisons of care units' survey results, eldercare representatives' explanations of the results, and what improvements will be made in order to do better in the next year's survey. With their use of truth-making rhetoric, press articles construct survey results as credible and valid, thus mirroring user perceptions and ultimately nursing home quality. The selection of nursing home representatives' comments equally reinforces the validity of claims.

Given nursing homes' problems with demonstrating success, the authors argue that media reports on the user survey is a way for eldercare organizations to achieve results in an otherwise resultless field, and while media reports might be seen as prompting change in nursing home care, what is ultimately achieved is the legitimation of a costly survey with low response rate.