Pradhan R, Ghiasi A, Orewa GN, Gupta S, Weech-Maldonado RJ.
Leadership instability in nursing homes, fueled by persistently high level of nursing home administrator (NHA) turnover, threatens the well-being of vulnerable residents. While numerous factors have been implicated, the impact of the industry's dominant player, for-profit corporate chains (FPCs), remains unexplored. Based upon the tenets from the structure-conduct-performance paradigm, the primary goal of this study is to examine the impact of corporate chain ownership on NHA turnover. Data were derived from different sources including LTCFocus and Care Compare (2021-2022). The dependent variable was NHA turnover. The main independent variable is ownership/chain affiliation, which represents a categorical variable of the four possible interactions of for-profit (FP) status and chain affiliation: FPC, FP independent (FPI), not-for-profit chain (NFPC), and not-for-profit independent (NFPI). An ordinal logistic regression model with year and state level fixed effects and appropriate organizational and market control variables was used. Compared to NFPI (reference group), FPC, FPI, and NFPC nursing homes exhibited approximately 2.3, 1.7, 1.4 times higher odds of NHA turnover, respectively. Corporate chain ownership significantly increases NHA turnover rates with variations among different ownership/chain affiliation combinations. Tailoring management strategies to the specific ownership structure may hold the key to reducing NHA turnover and ensuring consistent resident care.