The 1987 Nursing Home Reform Act as part of the Omnibus Reconciliation Act (OBRA) changed the nursing home administrator's role significantly. It introduced new requirements for quality of care, resident health assessment, care planning, use of medications, and physical restraints. Also adding to the burden of home administrators were the 1988 Medicare Catastrophic Coverage Act, which provided postacute reimbursement incentives; earlier hospital discharge of patients who were sicker; and proliferation of Alzheimer's disease and other specialized units. These changes demanded that nursing homes provide skilled subacute and specialty nursing care, whereas before they had primarily been caretakers of mostly long-stay residents needing custodial and comfort care.
The new regulations and demands sparked a dramatic turnover in nursing home administrators in the late 1980s and early 1990s, according to a study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00011). Many left their jobs voluntarily or were fired for poor performance, according to the researchers. They examined nursing home administrator turnover from 1970 to 1997 in all New York State nursing facilities, based on an analysis of data from the New York State Department of Health and facility data from 1991 to 1997.
One-half of all administrators hired in years immediately following OBRA 1987 were on the job less than a year. Yet more than half of the administrators on the job at the end of the study period had been on the job for more than 5 years. For example, in 1986, only 5 percent of nursing homes in New York State employed three or more different primary nursing home administrators during the calendar year. By 1990, the percentage of these high-turnover homes had doubled to 10 percent, which finally declined to 4 percent by 1997. The decrease in administrator turnover evident by 1997 suggests that many nursing homes had absorbed the initial shocks of OBRA and the postacute care boom.
See "External threats and nursing home administrator turnover," by Joseph Angelelli, Ph.D., David Gifford, M.D., M.P.H., Ann Shah, Ph.D., and Vincent Mor, Ph.D., in the summer 2001 Health Care Management Review 26(3), pp. 52-62.