Tenure, certification, and education of nursing home administrators, medical directors, and directors of nursing in for-profit and not-for-profit nursing homes: United States 2004.

Objectives: To understand key characteristics of the leadership team, and to examine if differences in these factors exist between for-profit (FP) and not-for-profit (NFP) nursing homes (NHs).

Design: Cross sectional.

Setting: US nursing homes.

Participants: A nationally representative sample of 1174 US NHs conducted in 2004.

Intervention: N/A.

Measurements: Reported data on tenure, education, and certification of NH administrators (NHAs), medical directors (MeDs), and directors of nursing (DoNs) at FP and NFP facilities.

Results: NHAs, MeDs, and DoNs at NFP facilities all had significantly greater tenure at their current facilities compared with their FP counterparts. NHAs and MeDs at NFP facilities were also more likely to have more years of accumulated experience in those roles. MeD certifications differed substantially by specialty, with 23.3%, 37.6%, and 43.5% of MeDs having certification in geriatric, internal, and family medicine, respectively, and about 42% of MeDs were certified by AMDA. However, no differences in MeD certification were observed by facility ownership. Although 68% of all US nursing homes had a MeD who spent 4 or fewer days per month in the facility and only 14% spent 11 days or more per month in the facility, nearly twice as many NFP MeDs spent 11 days or more onsite in the facility compared with FP MeDs. Facility ownership was strongly associated with NHA educational attainment, with a significantly higher proportion of NFP NHAs having master's degrees or higher (41.4% versus 26.6%, P < .0001), and smaller proportions of NFP NHAs having a bachelor's degree or less.

Conclusion: In 2004, members of the leadership teams of NFP NHs had more favorable profiles for several characteristics related to education and tenure compared with their FP counterparts. More research is needed to understand how variation in leadership skills and capacity affects quality of care and quality of work life outcomes, including the role of FP/NFP differences in explaining differential quality outcomes.