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The purpose of this dissertation is to examine nursing homes‟ compliance with state minimum nurse staffing standards and its relation to quality-of-care deficiencies. Specifically, this study, reviewing staffing standards from 50 states and the District of Columbia for the year 2007, proposes a unique algorithm to calculate the states‟ expected nurse staffing levels for individual nursing homes in order to investigate their compliance with the state nurse staffing standards. By using hierarchical linear modeling method, this study attempts to capture the impact of the staffing standards on actual nurse staffing levels under resource dependence perspectives. Path analysis using structural equation modeling was conducted to investigate both direct and indirect effects of the staffing standards on nurse staffing levels and quality-of-care deficiencies. The major findings were as follows: (1) nursing homes in states with higher state staffing standards for the categories of RN, LN, and total nurse were found to have higher RN, LN, and total staffing levels, respectively; (2) higher nurse staffing levels resulting from higher state staffing standards were significantly associated with better quality of care (less quality-of-care deficiencies cited) in nursing homes; and (3) state staffing standards were found to have much stronger contribution to nurse staffing levels than any other organizational or contextual factors while nurse staffing levels, particularly licensed staff, were found to have stronger contribution to quality-of-care deficiencies than any other organizational factors. The study findings suggest that if the goal is to increase nurse staffing levels for better quality, increasing the stringency of both federal and state nurse staffing standards would be the iv most effective way. However, the staffing standards first need technical changes to reduce their ambiguity and ensure their fairness. If the goal is to achieve better quality, merely increasing nurse staffing levels may not be effective since the variation of the quality-of-care deficiencies explained by exogenous variables was smaller than random variation 5%. If state Medicaid reimbursements can be utilized for financial incentives for better performing nursing homes, nursing homes may improve their productivity by efficiently managing organizational personnel or increasing job satisfaction among nursing practitioners. Lastly, longitudinal analysis, considering variation in length of state staffing policy implementations, is encouraged to investigate the long-term effects of state staffing standards on nurse staffing levels and quality of care.

The role of social capital in forming organizational commitment is the focus of this research. Organizational social capital is the idea that social relationships have value in the organization. The theoretical framework is based on Kanter's (1993) structure of organizational commitment. This research views the structure within organizations based on global empowerment, job satisfaction, organizational commitment, and social capital. In addition, the role that race, income, and education affect the organizational structure is also taken into account. The organizational configuration was assembled using a structural equation model with latent variables employing a sample of 235 certified nurse aides. The sample was collected from 10 nursing homes in the Dallas-Ft.Worth metropolitan area. It was expected that Kanter's general format is reestablished within the sample. In fact, the study found that empowerment significantly influences job satisfaction. In turn, job satisfaction does foster organizational commitment. Although Kanter's original thesis was supported in this analysis, it was also determined that social capital plays a significant mediating role in creating organizational commitment. Furthermore, this research indicates that social capital alone can create organizational commitment. Thus, in conclusion, this research builds on Kanter's original idea and argues that organizational commitment is based on job satisfaction, global empowerment, and social capital.

The purpose of this study was to examine a select set of organizational variables and determine their relationship to nursing assistants' intentions to quit in state-owned veterans' long-term care facilities located across the United States. America's long-term care industry (e.g., nursing homes, assisted living facilities) is a multibillion dollar industry. Because the U.S. government is projecting a 250% increase in the elderly population, staffing these nursing homes and related facilities is a critical concern. A vitally important but often overlooked factor of the long-term care industry is employee turnover. Of the staff in long-term care facilities, the nursing assistant (NA) position is particularly susceptible to turnover. Approximately 80% of NAs who enter the workforce leave within the 1st year and many leave within the first 3 months of employment. Some facilities report that they are unable to accept new residents because of a lack of qualified NAs. While many studies have researched this issue, staff turnover in long-term care facilities remains a serious and widespread problem. This study provides a foundation for future research related to the perceptions of intentions to quit of nursing assistants (NAs) working in state-owned veterans long-term care facilities by providing primary data regarding NAs intentions to quit. Results of this study indicate that NA intentions to quit might be reduced provided that pay and rewards are increased, workplace violence is addressed, and better access to patient care plans is provided. This research is useful to state-owned and operated long-term care facilities by giving them additional insights into nursing assistants' intentions to quit perhaps resulting in lower rates of turnover. It is suggested that future research be performed using populations of individuals from other segments of the long-term care industry, mainly, for-profit institutional care nursing homes, and federally owned veterans long-term care facilities.

Adverse drug events (ADE) cause many deaths annually in addition to affecting the quality of life of many others. The descriptive mixed methods approach, specifically exploratory case study and experimental design that guided this research utilized the survey and focus group methods to evaluate perceptions about robotic technology (RT) to reduce the rate of ADEs in U.S. nursing homes (NH). There is a lack of scholarly research into whether a conceptual approach rooted in RT can be implemented to assist with drug administrations in NHs. The purpose of this study was twofold. The first purpose was to evaluate the causes of ADEs specifically related to tablets, capsules, and pills. The second purpose was to evaluate the perceptions of nurses and administrators relative to the use of RT to assist in reducing ADEs. In the quantitative part, the sample means from 102 surveys from nurses and administrators were evaluated with the t test and the paired t test; while in the qualitative part, survey results, reported errors, and focus group data was assessed collectively. The research results did not indicate any new causes of ADEs and showed that the participants had a favorable perception of RT. Based on the results of this research, RT may be tailored in such a way that it can significantly reduce ADE occurrences for citizens in U.S. NHs.

The Social/HMO Demonstration evaluates the feasibility of expanding Medicare Supplemental Insurance benefits to cover a limited amount of ICF and community based long-term care (LTC) services provided under a comprehensive HMO benefit package for capitated Medicare beneficiaries. The policy research question addressed by this study is whether adding an Expanded Care Benefit (ECB) to the capitated HMO benefit package offered by Kaiser Permanente (KP) changes utilization patterns and costs of ICF services, and the probability of becoming Medicaid eligible. This study provides descriptive information regarding this policy research question. The research goal of this study is to measure the extent to which collective ICF use rates and expenditure patterns for S/HMO members are consistently the same, greater or less than baseline data of Risk HMO Medicare members who do not have the S/HMO ECB. The purpose of such measurement is to determine if an empirical basis exists for postulating an ICF utilization and expenditures outcome effect which is influenced by the S/HMO ECB. Utilization and financial data are collected from all SNF and ICF level nursing homes in Multnomah County for all Medicare beneficiaries enrolled in KP between June 1, 1986 and July 31, 1988. Eligibility data are assembled on all Medicare beneficiaries enrolled in KP during the same time period who were residents of Multnomah County. Nursing home use rates and rates for related expenditures are determined for all nursing home residents (1, 331) by their eligibility status in KP during the time of each nursing home stay. Days in an ICF are censored by transfers between Cost, Risk and S/HMO enrollment status. Rates are standardized by the age and gender distribution of research population members (19, 261) to adjust use rates for differences in age cohort distribution of Risk members and S/HMO members. Risk rates and S/HMO rates are compared and differences in utilization and expenditures are evaluated. Conclusions about such patterns are used to formulate hypotheses for testing and confirming descriptive observations. Findings show that overall S/HMO member rates are less than Risk member rates for five of the six Research Questions addressed in this study. Specifically, the probability of admission to an ICF is substantially greater for S/HMO members than for Risk members. However, S/HMO members remained in ICFs fewer days than Risk members, over the two year study period, as measured by age adjusted rates for ICF days per member year of eligibility during the study period. Difference in the mean length of ICF stay is statistically significant between Risk and S/HMO. The rate of total payments received by nursing homes for S/HMO ICF residents per 1000 S/HMO members was substantially less than that for Risk members. The rate of spend-down to welfare status was substantially lower for S/HMO members than for Risk members who became ICF residents. Higher proportions of S/HMO members were discharged from ICFs to home than were Risk members, which is consistent with S/HMO Expanded Care Benefit objectives.

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Typescript (photocopy). / Digitized by Kansas Correctional Industries

Call number: LD2668 .T4 1978 S687 / Master of Science

published_or_final_version / Social Work / Master / Master of Social Work