Academic journal article Journal of Health and Human Services Administration

Humanism in Nursing Homes: The Impact of Top Management

Academic journal article Journal of Health and Human Services Administration

Humanism in Nursing Homes: The Impact of Top Management

Article excerpt

In the U.S., approximately 20,000 nursing homes provide long-term care services to about 3.5 million elderly every year (National Nursing Home Survey, 2004). For some elderly the nursing home provides short-term rehabilitative care; but, for many other elders the nursing home becomes their final home (Castle & Engberg, 2007). Thus, the nursing home industry is in the business of providing both "nursing" (i.e., clinical care) services and "home" (i.e., social or humanistic care) services. These services are provided by a variety of staff, including nurse aides, registered nurses, and licensed practical nurses. In most nursing homes, staff, care, and services are coordinated by a top management team consisting of a nursing home administrator (NHA) and Director of Nursing (DON) (Castle, 2001).

Recent research has begun to show the importance of nursing home top management teams in the lives of residents (Anderson, Issel & McDaniel, 2003; Singh & Schwab, 2000; Zimmerman, Gruber-Baldini, Hebel, Sloane, & Magaziner, 2002). For example, the NHA's background and education is associated with the type of services provided (Castle, 2001). To date, this research has examined the impact of top management on the "nursing" component of care in the nursing home. Very little research has considered the impact of top management on the "home" component of care in the nursing home. However, top managers may be influential in this area. For example, programs such as the Eden Alternative, the Pioneer Network, and the Wellspring Institute provide models for implementing culture change in nursing homes that emphasizes humanistic caring (Stone, 413). In this research, we provide a first attempt at pinpointing ways in which top managers of nursing homes can provide or impact the humanistic component of care provided in their facilities. As noted in the Introduction to this symposium, by humanism we mean:

"Humanism in healthcare is a professional and organizational way of life that focuses on patient and family needs and interests, through quality healthcare, empathy, advocacy, and dedication to serving others... An exemplary healthcare organization will have a strong focus on delivering quality healthcare. The organization will also exhibit caring towards its clients, in empathic and compassionate clinical care, and through fostering positive interpersonal relationships between patients and all members of the organization." In the following sections, we first describe the nursing home top management team. Second, we examine the role of top managers in nursing homes. Third, we examine the role of top managers as leaders in the nursing home. Fourth, we summarize the literature examining the impact of top managers in nursing homes. Fifth, we examine developments in the nursing home industry that are influencing (or could potentially influence) the humanistic components of care. Finally, we provide suggestions for top managers, nursing home owners, and policy makers to create more caring humanistic environments.


Top managers of nursing homes are traditionally defined as the NHA and DON. These top managers serve as the operational leaders of their respective facilities. Although, we note that some recent initiatives have included the Medical Director as part of the top management team. For example, researchers at the University of Pittsburgh have labeled the NHA, DON, and Medical Director as "Three Peas in a Pod," wherein each member of the team complements the other ( However, research in this area is still rudimentary; thus, the NHA and DON are our primary focus.

We used data from the 2004 National Nursing Home Survey (NNHS) and primary data collected by the authors to provide descriptive information of NHAs and DONs. The NNHS is a nationally representative study of nursing homes conducted by the National Center for Health Statistics (http://www. …

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