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Federal and state governments collaborate on state Medicaid nursing facility long-term care (SMNF-LTC) programs. These programs are increasingly expensive as the baby-boomers retire. Yet serious resident outcome problems continue in spite of the Centers for Medicare and Medicaid Services’ (CMS) extensive process-focused regulatory efforts. This study identifies a promising and simpler auxiliary path for improving resident outcomes.

Drawing on a longitudinal (1997–2005), 48-state data set and panel-corrected, time-series regression, we compare the effects on resident outcomes of CMS process-focused surveys and four minimally regulated program structural features on which the states vary considerably.

We find that each of these four structural features exerts a greater effect on resident outcomes than process quality.

We suggest augmenting current process-focused regulation with a less arduous approach of more extensive regulation of these program features.

To date SMNF-LTC program regulation has focused largely on member facility processes. While regulating processes is appropriate, we show that regulating program structural features directly, an arguably easier task, might well produce considerable improvement in the quality of resident outcomes.

Attention has been increasingly devoted to the development of methods for assessing the quality of care in long‐term care (LTC) facilities, especially for government surveillance. A study is described which used the tracer method to provide data on the quality of care in Israeli LTC institutions. Advantages of the tracer method include its incorporation of structural, process and outcome measures and its focus on a number of representative tracer conditions. The study tested the ability of the tracer method to provide data on the quality of care, and facilitated adoption of this methodology by the government for their annual inspections.

Nursing facility inspections routinely produce statistics revealing sharp disparities in care at both the facility and the state level. But whether high rates of deficiencies are more indicative of stringent enforcement of standards, leading to improved care, or ongoing poor quality care remains unclear. Until this question is answered, families of nursing facility residents, responsible public officials and interested professionals, are all unable to make sound decisions about long-term care quality. We employ cross-sectional, panel data to compare states on multiple indices of both care quality and enforcement stringency. We use the multi-method-multi-trait approach to distinguish these concepts. We find that low rates of deficiencies are positively associated with independent measures of high quality care. But, a prominent nursing facility enforcement index likely registers poor quality care more than stringency of enforcement since it is associated positively with independent indices of poor quality care and negatively with independent measures of enforcement. Attentive publics can have reasonable confidence that low rates of deficiencies indicate high quality care. High rates tend to reflect glaring deterioration in care quality. They are less signals of stringent enforcement than of obviously poor care which prompts more visible enforcement activities. Sadly, there is little evidence suggesting that these enforcement measures improve state-level care quality and thus reduce cross-state disparities in the quality of nursing facility long-term care. However, at least some of the factors responsible for sharp disparities in nursing facility care lie within the capacity of states to rectify even in the short term.

Residents in under-resourced/high-Medicaid (85% or higher) nursing homes on average receive care from relatively lower quality providers and have worse health outcomes, which may increase the risk of higher COVID-19 incidence. This study aims to evaluate if having a culture that encourages employee empowerment results in better quality (lower COVID-19 deaths) in times of crisis, such as the current pandemic. The study combined primary survey data from 391 Directors of Nursing (response rate of 37%), with Centers for Medicare and Medicaid Services’ (CMS) Nursing Home COVID-19 Public File, LTCFocus, Area Health Resource File, and Nursing Home Compare. The dependent variable consisted of the number of COVID-19 death as of November 25, 2021. The independent variables consisted of Likert scale for employee empowerment (Cronbach alpha= 0.82). Control variables consisted of organizational factors (e.g., size, location, and ownership), as well as community factors (e.g., poverty, unemployment, and competition). The results indicated that one unit increase in employee empowerment was associated with 6% lower likelihood of having COVID-19 deaths. Nursing homes, particularly those under-resourced, face difficulty improving the quality of care due to financial constraints. However, the results suggest that adopting a culture that fosters employee empowerment may give nursing homes an edge in improving quality outcomes in crises.

This study aims to, chronicle literature, case studies and applied research to suggest that communications and public relations play a key role in the success of the best nursing homes and long‐term care facilities.

Research employed included a case study of four highly qualified nursing home facilities, followed by an electronic survey offered to all licensed nursing homes throughout New York State. Results from each segment of the research were compared and contrasted.

This research confirmed the thesis that long‐term care facilities which are independently identified as being high quality have a propensity to focus on communications with all stakeholders – particularly their residents and family members. Communications with all stakeholders are key to facility success.

The case study focused only on larger facilities; and survey response was limited without individual e‐mail addresses.

A set of guidelines for Communications in Nursing Homes and Long‐term Care Facilities was prepared as an outcome of the research.

This segment of the population is expected to more than double in the next 25 years, reaching nearly 90 million by 2050. The topic presents an important issue and sensitively considers it amidst a backdrop of change in western society.

The purpose of this paper is to establish the relationship between organisational culture and psychotropic medication use in residential care.

Cross-sectional analyses of staff and resident’s record survey in residential aged care facilities in Auckland, New Zealand (NZ). The competing values framework categorised organisational culture as clan, hierarchical, market driven or adhocracy and was completed by all staff. The treatment culture tool categorised facilities as having resident centred or traditional culture and was completed by registered nursing staff and general practitioners (GP). Functional and behavioural characteristics of residents were established by staff report and health characteristics and medications used were ascertained from the health record. Multiple regression was used to test for associations between measures of culture with psychotropic medication use (anxiolytics, sedatives, major tranquillisers).

In total 199 staff, 27 GP and 527 residents participated from 14 facilities. On average 8.5 medications per resident were prescribed and 42 per cent of residents received psychotropic medication. Having a diagnosis of anxiety or depression (odds ratio (OR) 3.18, 95 per cent confidence interval (CI) 1.71, 5.91), followed by persistent wandering (OR 2.53, 95 per cent CI 1.59, 4.01) and being in a dementia unit (OR 2.45, 95 per cent CI 1.17, 5.12) were most strongly associated with psychotropic use. Controlling for resident- and facility-level factors, health care assistants’ assignation of hierarchical organisational culture type was independently associated with psychotropic medication use, (OR 1.29, CI 1.08, 1.53) and a higher treatment culture score from the GP was associated with lower use of psychotropic medication (OR 0.95, CI 0.92, 0.98).

Psychotropic medication use remains prevalent in residential care facilities in NZ. Interventions aimed at changing organisational culture towards a less hierarchical and more resident-centred culture may be another avenue to improve prescribing in residential aged care.

This research explores perceptions of knowledge management processes held by managers and employees in a service industry. To date, empirical research on knowledge management in the service industry is sparse. This research seeks to examine absorptive capacity and its four capabilities of acquisition, assimilation, transformation and exploitation and their impact on effective knowledge management. All of these capabilities are strategies that enable external knowledge to be recognized, imported and integrated into, and further developed within the organization effectively. The research tests the relationships between absorptive capacity and effective knowledge management through analysis of quantitative data (n = 549) drawn from managers and employees in 35 residential aged care organizations in Western Australia. Responses were analysed using Partial Least Square-based Structural Equation Modelling. Additional analysis was conducted to assess if the job role (of manager or employee) and three industry context variables of profit motive, size of business and length of time the organization has been in business, impacted on the hypothesized relationships.

Structural model analysis examines the relationships between variables as hypothesized in the research framework. Analysis found that absorptive capacity and the four capabilities correlated significantly with effective knowledge management, with absorptive capacity explaining 56% of the total variability for effective knowledge management. Findings from this research also show that absorptive capacity and the four capabilities provide a useful framework for examining knowledge management in the service industry. Additionally, there were no significant differences in the perceptions held between managers and employees, nor between respondents in for-profit and not-for-profit organizations. Furthermore, the size of the organization and length of time the organization has been in business did not impact on absorptive capacity, the four capabilities and effective knowledge management.

The research considers implications for business in light of these findings. The role of managers in providing leadership across the knowledge management process was confirmed, as well as the importance of guiding routines and knowledge sharing throughout the organization. Further, the results indicate that within the participating organizations there are discernible differences in the way that some organizations manage their knowledge, compared to others. To achieve effective knowledge management, managers need to provide a supportive workplace culture, facilitate strong employee relationships, encourage employees to seek out new knowledge, continually engage in two-way communication with employees and provide up-to-date policies and procedures that guide employees in doing their work. The implementation of knowledge management strategies has also been shown in this research to enhance the delivery and quality of residential aged care.

One of the fastest growing service industries is long‐term care. Identifying the best performers in the industry in terms of service productivity is difficult because there is no single summary measure of outcomes, particularly quality outcomes. The purpose of the paper is to show the potential of data envelopment analysis (DEA) as a benchmarking method in long‐term care.

The paper provides background information on the long‐term care industry and describes the DEA methodology and applications to long‐term care. Data originated from two data sources with four databases furnishing information on 69 long‐term care facilities used.

In the hypotheses tested it was found that most of the models showed that for profit nursing homes were significantly more efficient than nonprofit. The exception was in the model that included the condition of patients as a co‐production input and then there was no significant difference in efficient performance between ownership types.

The paper shows the value of DEA as a method of benchmarking in the context of long‐term care.

The present study evaluates the effects of four‐component customer relationship management (CRM) on nursing home resident satisfaction by incorporating residents’ perceptions of service quality regarding physical environment and interaction with staff members in the nursing home. It also explores the mediating role of service quality between CRM and resident satisfaction.

A conceptual two‐level model that links CRM to resident satisfaction was developed and tested using data collected from nursing staff and residents in nursing homes in Taiwan. Data from 481 residents involving 45 nursing homes was collected via a questionnaire and analyzed using hierarchical linear modeling.

The results of this study show that most CRM components help nursing homes improve service quality and that perceived service quality positively influences resident satisfaction. This study also provides empirical support for the hypotheses that CRM helps nursing homes improve resident satisfaction through improving physical environment quality (PEQ) and interaction quality (IQ).

The findings highlight the importance of other aspects of CRM, not just information‐technology‐based CRM, to help nursing home staff provide customized offerings to residents and subsequently increase resident satisfaction with the nursing home. This research also points to PEQ and IQ as mediating mechanisms that can explain the association between CRM and resident satisfaction in the nursing home context.

This research investigate the beneficial effects of CRM by relating the comprehensive set of CRM components to service quality and resident satisfaction at the individual level. In addition, the present study points to residents’ perceptions of service quality as one of several mediating mechanisms that explains the association between CRM and resident satisfaction.