Associations Between Nursing Home Leadership Turnover and Resident Satisfaction

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ID: 313837
2026
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Abstract
BACKGROUND AND OBJECTIVES: The impact of nursing home administrator (NHA) and director of nursing (DON) turnover on residents' care experiences remains underexplored. This study aims to examine the associations of NHA/DON turnover with resident satisfaction scores. RESEARCH DESIGN AND METHODS: Five data sources were merged to create an aggregate dataset of 752 Ohio nursing homes in 2017: The Ohio Nursing Home Resident Satisfaction Survey, the Ohio Biennial Survey of Long-Term Care Facilities, the Certification and Survey Provider Enhanced Reports, Medicaid Cost Report, and LTCFocus. Resident satisfaction was measured by eight resident satisfaction scores: overall satisfaction score and seven individual domain scores. The scores were continuous variables ranging from 0 (low) to 100 (high). Leadership turnover was assessed using four specifications: one NHA turnover, two or more NHA turnover, one DON turnover, and two or more DON turnover over the past three years. Multiple linear regressions were conducted via SAS, adjusting for control variables. RESULTS: Two or more DON turnover are associated with a lower overall resident satisfaction score by 1.14% points (p < .05), lower Environment domain score by 1.01% points (p < .05), and lower Caregivers domain score by 1.80% points (p < .01). NHA turnover is not statistically associated with overall resident satisfaction score but positively associated with two individual domain scores. DISCUSSION AND IMPLICATIONS: DON turnover is associated with lower resident satisfaction scores, while NHA turnover is not. A single DON turnover may not harm residents' care experiences; however, frequent turnover among DON could negatively impact them.
Reference Key
openalex_W7160945319 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors J. Kwon, John R. Bowblis
Journal the gerontologist
Year 2026
DOI
10.1093/geront/gnag106
URL
https://doi.org/10.1093/geront/gnag106
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