essay on nursing home

97 Nursing Home Essay Topic Ideas & Examples

🏆 best nursing home topic ideas & essay examples, 📌 simple & easy nursing home essay titles, 🔎 most interesting nursing home topics to write about, ❓ nursing home research questions.

• Issue of Falls at a Nursing Home: Professional Reflection The problem of patients’ falls in nursing homes is an urgent nursing issue, and my experience in one of these institutions in New Zealand is the object of evaluation.
• Quality Costs for Building a Dementia Nursing Home Firstly, there will be the inclusion of the appraisal costs which entails the inspection and measurement of activities when the operation is ongoing to determine their conformity to the required standards.
• Older Patients’ Transition From a Hospital to a Nursing Home The example of transition of care chosen for further exploration is concerned with the transition of care from the hospital to the nursing home setting for patients that came to receive healthcare for various conditions.
• The Rehabilitation Center and Nursing Home During the evaluation process, the nurse leader identifies the problems in the organization and determines the strong and weak points, resources, gaps, and other factors that determine how the project will develop.
• A Nitrogen Gas Accident at a Nursing Home The nursing home workers failed to recognize this error and did not check the gas before hooking the tanks to the system.
• Approach to Learning at Cloudview Nursing Home Since the approach adopted to learning determines an organization’s performance, it is essential to understand the motivations for learning and their influence on workplace education.
• Regulation of a Large For-Profit Nursing Home Chain To solve the problem of unlawful actions of the stakeholders in nursing homes, there is a need for the implementation of the practical management theory.
• “Implementation and Effects of MRC in a Nursing Home” by Henskens The research’s dependent variable is the outcome to be measured the treatment’s impact on the aforementioned patients’ ADL and QoL. However, the researchers did not provide a clear delineation of the above-mentioned variables in the […]
• Nursing Home Beds: Fundamental Uncertainty and Values If it is assumed that the admission will stay the same, the decision to dismiss a certain amount of employees will reduce fixed costs in both facilities.
• A Nursing Home Working Scenario Working in nursing homes has its opportunities and challenges; therefore, the paper will cover the multidisciplinary teams’ working scenario, their interaction and diversity, communication in client care, and support accorded to clients considering their family, […]
• Nursing Home Blueprint and Requirements The aim of the facility should be geared towards the promotion of the health of the old patients through the prevention and treatment of diseases and disabilities.
• Departmental Budget Preparation for Nursing Home However, while the total population in our area of operation is expected to decrease, the population of people who are above 65 years in the US is projected to rise.
• Northern Cochise Nursing Home: Federal and State Surveys Following the findings of the health inspection carried out by Arizona Department of Health Services, the management of the Northern Cochise Nursing home took immediate steps to correct the deficiencies.
• Redondo Nursing Home: Providing Above Average Care While the potential resident and family members are expected to disclose all information pertaining to medical conditions, the planner is required to provide a complete description of the home.
• Organization Strategic Plan for a 40 Bed Nursing Home Unit The core values are to ensure that a team of the highest quality and honesty in delivering services attends to all.
• Activities Coordinator and a Conflict of Interest Situation at Cooinda Nursing Home It is thereby imperative that the practitioner adhere to the guidelines set by the home in such regards because he needs to check how his values and emotions are at par with the organizations, and […]
• Satisfaction With a Transitional Nursing Home Project The abstract does mention the dependant variable of the study viz.satisfaction with the transitional program; it does not, however, mention and discusses the various dimensions of the dependant variable that were measured in order to […]
• Nursing Home Designs: Health and Wellness of Aging The Eden Alternative is a nursing home model of care that places decision-making power into the hands of its clients and their families.
• Future Care Nursing Home in Baltimore City In the United States, up to one-half of the citizens will spend at least a few years of their lives in a nursing home.
• Choosing an Adult Foster Home or a Nursing Home A nursing home is well known to health and social services professionals as the long-term care service for older adults that accounts for that vast majority of public funding.
• Blumberg’s Nursing Home: Staffing Crisis The situation under analysis is complicated due to the level of awareness and the necessity to take immediate steps and fill the unstaffed positions.
• Employee Compensation and Benefits. Senior Secretary at Capital Nursing Home Limited The proposal demonstrates that the value of the employee’s benefits augmented with the annual salary and provides the total compensation. The total compensation package for the position of Senior Secretary includes the base pay and […]
• Fernhill Nursing Home Run by Colten Care Limited Staff management for my team is my responsibility; and of course I am a nurse so my basic role is providing general nursing care to the residents and any other role that might be allocated […]
• Reduce Hospitalization of Nursing Home Residents Publicity of INTERACT as a program having the necessary infrastructure and leadership commitment in health care matters for the elderly is one promising way that can be used to overcome these issues.
• The Effects of Group Music Making on the Wellbeing of Nursing Home Residents
• Assessing French Nursing Home Efficiency
• Assessing Nursing Home Care Quality Through Bayesian Networks
• Can Family Caregiving Substitute for Nursing Home Care
• Cost (In)Efficiency and Institutional Pressures in Nursing Home Chains
• The Difference Between Nursing Homes and Retirement Homes
• Direct Care Workers’ Response to Dying and Death in the Nursing Home
• Does Paid Family Leave Reduce Nursing Home Use
• Economic Disability and Health Determinants of the Hazard of Nursing Home Entry
• Effective Human Resources Leadership for Nursing Home
• Elder Abuse Within Nursing Home Setting
• Elderly Falls Within the Nursing Home
• End-Of-Life Decision Making for Nursing Home Residents With Dementia
• Impact of Family Structure on the Risk of Nursing Home Admission
• Nursing Home Facility Versus a General Acute Care Hospital
• Improving Wound and Pressure Area Care in a Nursing Home
• Nursing Home Environment and Pet Therapy Programs
• The Effects of 1935’s Social Security Act on the Nursing Home Industry
• Nursing Home Care Versus Assisted Living Care
• Health Care Utilization Nursing Home Administration
• Nursing Home Staff Turnover and Better Practices
• Mental Disorders Among Non-Elderly Nursing Home Residents
• Forecasting Nursing Home Utilization of Elderly Americans
• Incorporating Quality Into Data Envelopment Analysis of Nursing Home Performance
• Interventions That Encourage High-Value Nursing Home Care
• Lateral Violence and Uncivil Behavior in a Nursing Home
• Medicaid and the Cost of Improving Access to Nursing Home Care
• Medicaid Reimbursement and the Quality of Nursing Home Care
• Who Makes the Decision to Go to a Nursing Home
• Understanding the Medical Aspect of a Nursing Home
• The Fate and Welfare of Nursing Home Residents
• The Social Security Act of Nursing Home Facilities
• Physical Restraint in Nursing Home Facilities
• Predicting Nursing Home Utilization Among the High-Risk Elderly
• How Many Nursing Home Residents Live With a Mental Illness
• Improving the Nursing Home: A Framework for Professional Nursing Practice
• Incapacitated vs. Incompetence: Employees in the Nursing Home Industry
• An Argument in Enhancing the Care Quality in a Nursing Home
• How to Prevent Accidents in Nursing Homes
• Positive and Negative Views of Nursing Homes
• What Are the Benefits of Living in a Nursing Home?
• Do People Live Longer at Home or in a Nursing Home?
• What Is the Main Purpose of a Nursing Home?
• Why Is Assisted Living Better Than a Nursing Home?
• Which Are the Most Important Problems of Nursing Home Residents?
• How Do You Know When Someone Is Ready for a Nursing Home?
• What Participation and Knowledge Are Associated with Nursing Home Admission Decisions Among the Working-Age Population?
• Is It Bad to Put Your Parents in a Nursing Home?
• What Is the Most Common Diagnosis in Nursing Homes?
• How Did the Social Security Act of 1935 Affect the Nursing Home Industry?
• Can a Doctor Put Someone in a Nursing Home?
• How Can You Improve the Quality of Life in a Nursing Home?
• What Are the Most Common Reasons Seniors Are Placed in a Nursing Home?
• Are Nursing Homes Better Than Care Homes?
• What Is the Difference Between a Nursing Home and a Senior Home?
• How Can the Risk of Violence in Nursing Homes Be Reduced?
• What Are the Perspectives and Expectations of Telemedicine Opportunities from Families of Nursing Home Residents and Nursing Home Caregivers?
• How Do You Deal with the Guilt of Putting Your Parents in a Nursing Home?
• What Percentage of Nursing Home Residents Are Depressed?
• Is a Nursing Home the Best Choice for the Elderly?
• What Are the Physical, Intellectual, Emotional, and Social Benefits of Various Stimulating Activities for Nursing Home Residents?
• How to Deal With Collateral Violence and Indecent Behavior in a Nursing Home?
• What Are Nursing Home Residents’ Views on Dying and Death?
• How Often Should You Visit Your Mother in a Nursing Home?
• What Is the Difference Between a Residential Care Home and a Nursing Home?
• Should Elderly Parents Live in a Nursing Home or Not?
• What Is the Social Security Act of Nursing Home Facilities?
• How Can Human Resources Improve Nursing Home Management?
• What Are the Disadvantages of Living in a Nursing Home?
• How Important Is the Medical Aspect of a Nursing Home?
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Reflection on an experience in a nursing home

Info: 1620 words (6 pages) Nursing Essay Published: 13th Feb 2020

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What working in a nursing home taught me about life, death, and America’s cultural values

by Valery Hazanov

The first thing I noticed when I began working in a nursing home was the smell. It's everywhere. A mix of detergent and hospital smell and, well, people in nursing homes wear diapers. It's one of those smells that takes over everything — if you're not used to it, it's hard to think about anything else.

Being in the nursing home is tough. People weep and smell and drool. Sometimes you can go on the floor and hear a woman in her 90s scream, "I want Mommy."

But it's also ordinary — just people living together: gossiping, daydreaming, reading, watching TV, scratching their back when it itches.

For the past eight months I have been working as a psychotherapist with dying patients in nursing homes in New York City. It's an unusual job for a psychotherapist — and the first one I took after graduating with a PhD in clinical psychology. My colleagues were surprised. "Why not a hospital? Or an outpatient clinic? Do the patients even have a psychiatric diagnosis?"

The short answer is that I wanted to see what death looks and feels like — to learn from it. I hope that I can also help someone feel a little less lonely, a little more (is there a measure to it?) reconciled.

I haven't gotten used to the smell yet. But I have been thinking a lot about the nursing home and the people who live and die there, and wanted to share what I learned.

1) At the end, only the important things remain

"This is all I have left," a patient recently told me, pointing to a photograph of himself and his wife.

It made me notice the things people bring to the nursing home. The rooms are usually small, so what people bring is important to them. If they have a family, there will be photos of them (most popular are the photos of grandchildren). There might also be a few cherished books, a get-well-soon card, a painting by a grandchild or a nephew, some clothes, maybe flowers. And that's about it. The world shrinks in the nursing home, and only a few things remain: things that feel important — like they're worth fighting for, while we still can.

2) Having a routine is key to happiness

More on dying well.

It's never too early to start thinking about your own death

I'm a little lazy. My ideal vacation is doing nothing, maybe on a deserted beach somewhere. I look in terror upon very scheduled, very planned people. Yet I have been noticing that doing nothing rarely fills me with joy, while doing something sometimes does. Hence, the conflict: Should I push myself to do things, or should I go with the flow and do things only when I feel like doing them? Being in a nursing home changed my perspective somewhat: I noticed that all the patients who do well follow a routine. Their routines are different but always involve some structure and internal discipline.

I am working with a 94-year-old woman. She wakes up at 6:30 am every day, makes her bed, goes for a stroll with a walker, eats breakfast, exercises in the "rehabilitation room," reads, eats lunch, naps, goes for another walk, drinks tea with a friend, eats dinner, and goes to bed. She has a well-defined routine. She pushes herself to do things, some of which are very difficult for her, without asking herself why it is important to do them. And, I think, this is what keeps her alive — her movement, her pushing, is her life.

Observing her, I have been coming to the conclusion that it might be true for all of us. And I often think about her when I am debating whether to go for a run or not, whether to write for a couple more hours or not, whether to finally get up from the couch and clean my apartment or not — she would do it, I know, so maybe I should, too.

3) Old people have the same range of emotions as everyone else

"You are so handsome. Are you married?" is something I hear only in extended-family gatherings and in nursing homes. People flirt with me there all the time. This has nothing to do with their age or health — but rather with whether they are shy. When we see someone who is in his 90s and is all bent and wrinkled and sits in a wheelchair, we might think he doesn't feel anything except physical pain — especially not any sexual urges. That's not true.

As long as people live, they feel everything. They feel lust and regret and sadness and joy. And denying that, because of our own discomfort, is one of the worst things we can do to old people.

Patients in nursing home gossip ("Did you know that this nurse is married to the social worker?"), flirt, make jokes, cry, feel helpless, complain of boredom. "What does someone in her 80s talk about?" a colleague asked me. "About the same things," I replied, "only with more urgency."

Some people don't get that, and talk to old people as if they were children. "How are we today, Mr. Goldstein?" I heard someone ask in a high-pitched voice of a former history professor in his 80s, and then without waiting for a response added, "Did we poopie this morning?" Yes, we did poopie this morning. But we also remembered a funny story from last night and thought about death and about our grandchildren and about whether we could sleep with you because your neck looks nice.

4) Old people are invisible in American culture

People at the nursing home like to watch TV. It's always on. How strange, then, that there are no old people on TV.

Here's a picture I see every day: It's the middle of the day and there is a cooking show or a talk show on, and the host is in her 50s, let's say, but obviously looks much younger, and her guest is in his 30s or 50s and also looks younger, and they talk in this hyper-enthusiastic voice about how "great!" their dish or their new movie is, or how "sad!" the story they just heard was. Watching them is a room full of pensive people in their 80s and 90s who are not quite sure what all the fuss is about. They don't see themselves there. They don't belong there.

I live in Brooklyn, and I rarely see old people around. I rarely see them in Manhattan, either. When I entered the nursing home for the first time I remember thinking that it feels like a prison or a psychiatric institution: full of people who are outside of society, rarely seen on the street. In other cultures, old people are esteemed and valued, and you see them around. In this manic, death-denying culture we live in, there seems to be little place for a melancholic outlook from someone that doesn't look "young!" and "great!" but might know something about life that we don't.

There isn't one Big Truth about life that the patients in the nursing home told me that I can report back; it's a certain perspective, a combination of all the small things. Things like this, which a patient in her 80s told me while we were looking outside: "Valery, one day you will be my age, God willing, and you will sit here, where I sit now, and you will look out of the window, as I do now. And you want to do that without regret and envy; you want to just look out at the world outside and be okay with not being a part of it anymore."

5) The only distraction from pain is spiritual

Some people in the nursing home talk about their physical pain all the time; others don't. They talk about other things instead, and it's rarely a sign of whether they are in pain or not.

Here's my theory: If for most of your life you are concerned with the mundane (which, think about it, always involves personal comfort) then when you get old and feel a lot of pain, that's going to be the only thing you're going to think about. It's like a muscle — you developed the mundane muscle and not the other one.

And you can't start developing the spiritual muscle when you're old. If you didn't really care about anything outside of yourself (like books, or sports, or your brother, or what is a moral life), you're not going to start when you're old and in terrible pain. Your terrible pain will be the only thing on your mind.

But if you have developed the spiritual muscle — not me, not my immediate comfort — you'll be fine; it will work. I have a couple of patients in their 90s who really care about baseball — they worried whether the Mets were going to make the playoffs this year, so they rarely talked about anything else; or a patient who is concerned about the future of the Jewish diaspora and talks about it most of our sessions; or a patient who was worried that not going to a Thanksgiving dinner because of her anxieties about her "inappropriately old" appearance was actually a selfish act that was not fair to her sister. Concerns like these make physical pain more bearable, maybe because they make it less important.

6) If you don't have kids, getting old is tough

The decision to have kids is personal, and consists of so many factors: financial, medical, moral, and so on. There are no rights or wrongs here, obviously. But when we are really old and drooling and wearing a diaper, and it's physically unpleasant to look at our wounds or to smell us, the only people who might be there consistently, when we need them, are going to be either paid to do so (which is okay but not ideal) or our children. A dedicated nephew might come from time to time. An old friend will visit.

But chances are that our siblings will be very old by then, and our parents will be dead, which leaves only children to be there when we need it. Think about it when you are considering whether to have children. The saddest people I see in the nursing home are childless.

7) Think about how you want to die

José Arcadio Buendía in One Hundred Years of Solitude dies under a tree in his own backyard. That's a pretty great death.

People die in different ways in the nursing home. Some with regrets; others in peace. Some cling to the last drops of life; others give way. Some planned their deaths and prepared for them — making their deaths meaningful, not random. A woman in her 90s recently told me, "Trees die standing tall." This is how she wants to go: standing, not crawling.

I think of death as a tour guide to my life — "Look here; pay attention to this!" the guide tells me. Maybe not the most cheerful one, slightly overweight and irritated, but certainly one who knows a lot and can point to the important things while avoiding the popular, touristy stuff. He can tell me that if I want to die under a tree in my backyard, for example, it might make sense to live in a house with a backyard and a tree. To you, he will say that if you don't want any extra procedures done to you at the end, it might make sense to talk about it with the people who will eventually make this decision. That if you want to die while hang-gliding over an ocean, then, who knows, maybe that's also possible.

My father, who has spent the past 30 years working in an ICU as a cardiologist and has seen many deaths, once told me that if he had to choose, he would choose dying well over living well — the misery of a terrible, regretful death feels worse to him than a misery of a terrible life, but a peaceful death feels like the ultimate reward. I think I am beginning to see his point.

I am 33. Sometimes it feels like a lot — close to the end; sometimes, it doesn't. Depends on the day, I guess. And like all of us, including the people in the nursing home, I am figuring things out, trying to do my best with the time I have. To not waste it.

Recently, I had a session with a woman in her 90s who has not been feeling well.

"It's going in a very clear direction," she told me. "Toward the end."

"It's true for all of us," I replied.

"No, sweetheart. There is a big difference: You have much more time."

Valery Hazanov, PhD , is a clinical psychologist in Brooklyn. He is writing a book about his training to become a psychotherapist.

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How to Write a Nursing Essay with a Quick Guide

Ever felt the blank-page panic when assigned a nursing essay? Wondering where to start or if your words will measure up to the weight of your experiences? Fear not, because today, we're here to guide you through this process.

Imagine you're at your favorite coffee spot, armed with a cup of motivation (and maybe a sneaky treat). Got it? Great! Now, let's spill the secrets on how to spin your nursing tales into words that not only get you that A+ but also tug at the heartstrings of anyone reading. We've got your back with nursing essay examples that'll be your inspiration, an outline to keep you on the right path, and more!

What Is a Nursing Essay

Let's start by dissecting the concept. A nursing essay serves as a focused exploration of a specific aspect of nursing, providing an opportunity for students to demonstrate their theoretical knowledge and its practical application in patient care settings.

Picture it as a journey through the challenges and victories of a budding nurse. These essays go beyond the classroom, tackling everything from tricky ethical dilemmas to the impact of healthcare policies on the front lines. It's not just about grades; it's about proving, 'I'm ready for the real deal.'

So, when you read or write a nursing essay, it's not just words on paper. It's like looking into the world of someone who's about to start their nursing career – someone who's really thought about the ins and outs of being a nurse. And before you kick off your nursing career, don't shy away from asking - write my essay for me - we're ready to land a professional helping hand.

How to Start a Nursing Essay

When you start writing a nursing essay, it is like gearing up for a crucial mission. Here's your quick guide from our nursing essay writing service :

Choosing Your Topic: Select a topic that sparks your interest and relates to real-world nursing challenges. Consider areas like patient care, ethical dilemmas, or the impact of technology on healthcare.

Outline Your Route : Plan your essay's journey. Create a roadmap with key points you want to cover. This keeps you on track and your essay on point.

Craft a Strong Thesis: Assuming you already know how to write a hook , kick off your writing with a surprising fact, a thought-provoking quote, or a brief anecdote. Then, state your main argument or perspective in one sentence. This thesis will serve as the compass for your essay, guiding both you and your reader through the rest of your writing.

How to Structure a Nursing Essay

Every great essay is like a well-orchestrated performance – it needs a script, a narrative that flows seamlessly, capturing the audience's attention from start to finish. In our case, this script takes the form of a well-organized structure. Let's delve into the elements that teach you how to write a nursing essay, from a mere collection of words to a compelling journey of insights.

Nursing Essay Introduction

Begin your nursing essay with a spark. Knowing how to write essay introduction effectively means sharing a real-life scenario or a striking fact related to your topic. For instance, if exploring patient care, narrate a personal experience that made a lasting impression. Then, crisply state your thesis – a clear roadmap indicating the direction your essay will take. Think of it as a teaser that leaves the reader eager to explore the insights you're about to unfold.

In the main body, dive into the heart of your essay. Each paragraph should explore a specific aspect of your topic. Back your thoughts with examples – maybe a scenario from your clinical experience, a relevant case study, or findings from credible sources. Imagine it as a puzzle coming together; each paragraph adds a piece, forming a complete picture. Keep it focused and let each idea flow naturally into the next.

Nursing Essay Conclusion

As writing a nursing essay nears the end, resist the urge to introduce new elements. Summarize your main points concisely. Remind the reader of the real-world significance of your thesis – why it matters in the broader context of nursing. Conclude with a thought-provoking statement or a call to reflection, leaving your reader with a lasting impression. It's like the final scene of a movie that leaves you thinking long after the credits roll.

Nursing Essay Outline

Before diving into the essay, craft a roadmap – your outline. This isn't a rigid skeleton but a flexible guide that ensures your ideas flow logically. Consider the following template from our research paper writing service :

Introduction

• Opening Hook: Share a brief, impactful patient care scenario.
• Relevance Statement: Explain why the chosen topic is crucial in nursing.
• Thesis: Clearly state the main argument or perspective.

Patient-Centered Care:

• Definition: Clarify what patient-centered care means in nursing.
• Personal Experience: Share a relevant encounter from clinical practice.
• Evidence: Integrate findings from reputable nursing literature.

Ethical Dilemmas in Nursing Practice

• Scenario Presentation: Describe a specific ethical challenge faced by nurses.
• Decision-Making Process: Outline steps taken to address the dilemma.
• Ethical Frameworks: Discuss any ethical theories guiding the decision.

Impact of Technology on Nursing

• Current Trends: Highlight technological advancements in nursing.
• Case Study: Share an example of technology enhancing patient care.
• Challenges and Benefits: Discuss the pros and cons of technology in nursing.
• Summary of Key Points: Recap the main ideas from each section.
• Real-world Implications: Emphasize the practical significance in nursing practice.
• Closing Thought: End with a reflective statement or call to action.

A+ in Nursing Essays Await You!

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Nursing Essay Examples

Here are the nursing Essay Examples for you to read.

Nursing Essay Writing Tips Video

When it comes to crafting a stellar nursing essay, a few key strategies can elevate your work from ordinary to exceptional. Here are some valuable tips from our medical school personal statement writer :

Connect with Personal Experiences:

• Approach: Weave personal encounters seamlessly into your narrative.
• Reasoning: This not only adds authenticity to your essay but also serves as a powerful testament to your firsthand understanding of the challenges and triumphs in the nursing field.

Emphasize Critical Thinking:

• Approach: Go beyond describing situations; delve into their analysis.
• Reasoning: Nursing essays are the perfect platform to showcase your critical thinking skills – an essential attribute in making informed decisions in real-world healthcare scenarios.

Incorporate Patient Perspectives:

• Approach: Integrate patient stories or feedback into your discussion.
• Reasoning: By bringing in the human element, you demonstrate empathy and an understanding of the patient's experience, a core aspect of nursing care.

Integrate Evidence-Based Practice:

• Approach: Support your arguments with the latest evidence-based literature.
• Reasoning: Highlighting your commitment to staying informed and applying current research underscores your dedication to evidence-based practice – a cornerstone in modern nursing.

Address Ethical Considerations:

• Approach: Explicitly discuss the ethical dimensions of your topic.
• Reasoning: Nursing essays provide a platform to delve into the ethical complexities inherent in healthcare, showcasing your ability to navigate and analyze these challenges.

Balance Theory and Practice:

• Approach: Connect theoretical concepts to real-world applications.
• Reasoning: By bridging the gap between theory and practice, you illustrate your capacity to apply academic knowledge effectively in the dynamic realm of nursing.

Highlight Interdisciplinary Collaboration:

• Approach: Discuss collaborative efforts with other healthcare professionals.
• Reasoning: Acknowledging the interdisciplinary nature of healthcare underscores your understanding of the importance of teamwork – a vital aspect of successful nursing practice.

Reflect on Lessons Learned:

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Nursing Homes In The US Argumentative Essay Samples

Type of paper: Argumentative Essay

Topic: Elderly , Health , Home , Medicine , Services papers , Nursing , Family , Love

Words: 2500

Published: 03/16/2020

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Employing the services of Nursing Homes is becoming a huge trend in the United States in recent years. Families can bring their elderly and ailing love ones to these nursing homes and pay for a certain cost to support their treatment. However, there is a growing debate within the country with regards to the use of these nursing homes as some groups believe families should take care of their love ones at home. Supporters to these alternative facilities argue that nursing homes would provide better care to their love ones, especially given the financial and living conditions. This paper will discuss the arguments surrounding the use of nursing home for love ones and answer as to why placing them to these homes would be beneficial or disadvantageous for the families thinking of using the service.

Placing Love Ones in Nursing Homes

When a person reaches the age of 70, family members would start clamoring for ideas as to what would be done in order to take care of their elderly family member. Some families opt to consider assigning someone to take care of their love ones at home due to the strict schedules of people today. Others would take care of their love ones by themselves due to the sentiment that it is the child’s responsibility to give back to their love ones. However, in recent years, there is a growing interest in many families to seek the assistance of nursing homes in order to take care of these elderly or ailing family members. Positions have greatly varied within the public regarding the presence of these nursing homes. Some argue that these nursing homes should not be trusted, while a few welcome its use. Families should place their love ones in nursing homes because these love ones would be taken care well by these nursing homes as they specialize in taking care of the specialized needs of these elderly and ailing family members despite the costs it entails. The exact definition of nursing homes have varied throughout the years given the lack of terminology for these services in the early years. However, according to Giacalone (2001), the National Center for Health Statistics (NCHS) defined nursing homes as “facilities with three or more beds that is either licensed as a nursing home by the state, certified as a nursing facility under Medicare or Medicaid, identified as a nursing unit in a retirement center, or determined to provide nursing or medical care”. Some institutions also call these facilities as extended care facilities, intermediate care facilities for the mentally retarded and SNFs. Nursing homes often have state-of-the-art medical facilities and medical staff that can be called to duty 24/7. Before nursing homes can operate in the United States, they would have to apply for state licenses and adhere to reimbursement regulations, classification and termination policies. Most of these policies vary per state and some states would require separate licenses for nursing homes that have separate operations on all-day care facilities or medical accreditation . Purdy (2013) stated that nursing homes became known in the US since the 1930 when many American families brought their ailing family members to “poor houses.” Many criticized these poor houses due to their deplorable living conditions and health care. In 1935, the Congress passed the Social Security Act which was included in the New Deal program to support its aging population. Federal grants were given per state in order to improve health care, as well as the creation of nursing homes for the elderly and ailing. By the 1950s, nursing homes were licensed and at the same time, criticized for their operations. From the 50s to the 80s, exploitation was prominent in the industry and misled many Americans in the process. The government immediately responded in 1965 by passing the Older Americans Act and the Title III grants which would establish the community program for the elderly which would cater not just for their medical needs but also for their maintenance. Studies were also supportive over the initiative of the government and aided in the establishment of the Nursing Home Reform Act of 1987, which would regulate Medicare and Medicaid in providing financial assistance to nursing homes. The Act also added the necessary requirements for nursing home licensing. Since the growth of these nursing homes throughout the country, there are several sentiments that have been raised with regards to leaving loved ones in these nursing homes. Opponents cited three major arguments against nursing homes: cost and quality, reduction of self-reliance and independence and the trauma it entails to the loved ones. In terms of costs, it is reported by Ellis (2013) that nursing home services now costs up to $80,000 a year in comparison to its $67,527 five years ago. According to the Genworth 2013 Cost of Care Survey, factors such as insurance, food, maintenance and labor have triggered the increase of nursing home costs. As a result of these higher costs, a simple semi-private room nowadays now rate up to $75,405, 23% higher than it was five years ago. With these high fees, people tend to prefer using assistive living facilities that cost only up to $41,400. Others also prefer at-home care because it is cheaper to do these treatments at home, and they would also find it cheaper to pay for food and services . Hand in hand with the high costs is the quality of care these nursing homes can provide to family’s loved ones. Pesis-Katz, Phelps, Temkin-Greener, Spector, Veazie, and Mukamel (2013) stated that consumers are often misled by the high hotel-like quality of nursing homes around the country due to the misleading and inaccurate information available. Some of the information available for prospect residents come from the internet and sometimes, it is not easy to understand. Since customers cannot interpret and understand the information with regards to the quality of health care, they often prefer to select nursing homes with high grade hotel type service. They often use indirect methods to observe if the nursing home is good for their love ones. Some factors they take into consideration are nonprofit ownership and the number of occupancy, seeing it as a sign for high quality for its service and capability. As a result of the inconsistency of information, it is likely that the service they would get would not be suitable for their love ones . Loved ones who are placed in these nursing homes also feel the reduction of self-reliance and independence. According to the Illinois Council on Long Term Care (n.d.), any person who is admitted to nursing homes would lose their privileges to keep their apartments and homes. Most of their possessions would also be sold or given to charity, removing the possibility for the person to give the possessions as an inheritance to their children or grandchildren. Nursing homes only allow just a few possessions for these loved ones to hold; however, they would have to fit it on a small space that sometimes, they share with another person. Aside from losing their homes, loved ones admitted to nursing homes would also cause a loss of status, finances and relationships that may affect the loved one’s confidence and independence. Residents are also restricted from their movements considering that every activity is now timed by the institution and where the resident would need to stay. Finally, there are also implications to loved ones when they are placed in nursing homes, mostly changing their attitudes and development of trauma. Many would become angry for being placed in a nursing home especially with the loss of their possessions and rights. Some elderly often get angry because of the restrictions placed on their movements while in these institutions. As a result of their anger, they would become trouble-makers in the nursing home and it may hinder their recovery. Some, especially those who lose their love ones prior to their admission to these institutions, would feel bouts of depression or even regression. These residents would become overly dependent towards their caretakers or their love ones. There are also bouts of denial for these residents as they would feel that their condition or placement in the nursing home is not true. They believe that they would be removed from these centers soon and go home afterwards . However, while there are people against the use of nursing homes in the country, many Americans today prefer to use nursing homes due to the benefits it has for both the family and the love one that would be enrolled in this service. Many often prefer sending their loved ones on these nursing homes due to the all-round care provided by these facilities. According to the report by Sun Advocate (2008) and EHealthMedicare (n.d.), many of America’s nursing homes have available professionals to cater to emergencies and immediate medical support 24 hours a day. While doctors may not always be available in the early hours of the day, nurses are trained to take care of their patients and do rounds regularly. If these love ones were taken care of at home, their family members would not be able to cater to the exact need of the ailing or elderly loved one. The family would have to adopt with the schedule of the elder, which may prevent them from going to their own duties on time. With nursing homes available, families can visit their family members on free days and be assured that their love ones are treated and monitored regularly. In addition, these professionals and personnel can also provide specialized treatment necessary to improve the health and well-being of the citizen. Nursing homes have custodial care, which aids in preparing meals, bathing and dressing for their residences. The skilled nursing care unite is where the nurses and rehabilitation specialist would determine what type of care or treatment would be done. This type of care would include activities such as medication management, wound care and specialized functions depending on the availability of medical equipment in the facility. Some facilities also offer rehabilitation services, especially for patients which have been placed under surgery and other strenuous activity. The doctor of the resident would be able to determine as to how long rehabilitation would occur. Finally, nursing homes are also well known for their long-term care facilities to aid patients with major diseases. Prescription drugs and medical supplies are also readily available for use by these workers to ensure continuous service and treatment for residents. Nursing homes also allow their love ones to meet up new friends and acquaintances as nursing homes are like small communities. In at-home treatments and care, the elderly or ailing family member would only have limited contact with their peers. However, in nursing homes, they are able to be with their age group and even go on regular social gatherings and celebrations: may it be visits to museums or simple group meals in the nursing home. In some instances, nursing homes actually incite socialization given that the nursing home acts as a special home for its patients and residents. They can use the open kitchens and public areas to meet up with their fellow residents. Nursing homes also may have sectors catering for other in-need residents, who are not necessarily elderly. They may also find certain nursing homes that would permit couples in staying together to provide a good environment for their development and recovery. Nursing homes are also quite safe and promises to provide excellent service as these nursing homes are regularly checked by the United States government for their capacity and services. Medicare and Medicaid also provide regular reviews to the public in order to determine which nursing homes adhere to their policies. Evaluations are done regularly to ensure that quality is not compromised and it is expected that nursing homes update their programs to stay up-to-date to the new improvements in healthcare . Nursing homes also make sure that patients do not endanger themselves further especially with the onset of very complicated diseases like dementia and Alzheimer’s . Family must always be cherished no matter what one feels about each family member. As these family members get older, it is crucial that they are given all the love and care possible to make their lives comfortable in their final years. However, taking care of these ailing and elderly family members can be very difficult especially due to the medical and financial needs of these loved ones. With the introduction of nursing homes, families now have a choice to use these services to take care of their love ones. On the one hand, these nursing homes can be quite costly each year and it is a question as to whether or not the service matches the cost. These nursing homes can even make the situation of the elderly and ailing family members to worsen due to the impact of their residencies. On the other hand, using nursing homes not only benefits the family member but also the family in general. The family member would greatly benefit due to the ready access to health care, while family members would be relieved with the financial burden attached with taking care of these love ones.

Centers for Disease Control and Prevention. (2014, May 14). Nursing Home Care. Retrieved from CDC FastStats: http://www.cdc.gov/nchs/fastats/nursing-home-care.htm EHealth Medicare. (n.d.). Nursing Homes and Medicare. Retrieved from EHealthMedicare: http://www.ehealthmedicare.com/about-medicare/nursing-homes/ Ellis, B. (2013, April 9). Nursing home costs top $80,000. Retrieved from CNN Money: http://money.cnn.com/2013/04/09/retirement/nursing-home-costs/ Giacalone, J. (2001). The U.S. Nursing Home Industry. New York: M.E. Sharpe. Illinois Council on Long Term Care. (n.d.). Understanding the Transition to Life in a Nursing Home. Retrieved from Family Resource Center: http://nursinghome.org/fam/fam_004.html Pesis-Katz, I., Phelps, C. E., Temkin-Greener, H., Spector, W. D., Veazie, P., & Mukamel, D. B. (2013). Making Difficult Decisions: The Role of Quality of Care in Choosing a Nursing Home. American Journal of Public Health, 103(5). Purdy, E. (2013). Nursing homes. Ipswich: Salem Press. Sun Advocate. (2009, April 10). Advantages and disadvantages of nursing home care for the elderly. Retrieved from Sun Advocate: http://www.sunad.com/index.php?tier=1&article_id=12944

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Home — Essay Samples — Nursing & Health — Medicare — The Benefits of Nursing Homes

The Benefits of Nursing Homes

• Categories: Medicare

About this sample

Words: 498 |

Published: Jul 17, 2018

Words: 498 | Page: 1 | 3 min read

Works Cited

• Johnson, R. W., & Wiener, J. M. (2006). A Profile of Frail Older Americans and Their Caregivers. The Urban Institute.
• Bullock, K., & Hamblin, A. (2008). The Development of Community-Based Services for Older People: A Focus on Home Care. The British Journal of Social Work, 38(3), 541-558.
• Kane, R. A., & Kane, R. L. (2000). Assessing Older Persons: Measures, Meaning, and Practical Applications. Oxford University Press.
• Gitlin, L. N., Winter, L., Dennis, M. P., Hodgson, N., & Hauck, W. W. (2010). Targeting and Managing Behavioral Symptoms in Individuals With Dementia: A Randomized Trial of a Nonpharmacological Intervention. Journal of the American Geriatrics Society, 58(8), 1465-1474.
• Gaugler, J. E., Mittelman, M. S., Hepburn, K., Newcomer, R., & Dorn, K. (2010). Effects of Dementia Caregiving on Caregiver Depressive Symptoms, Social Support, and Health: A Longitudinal Analysis. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 65B(6), 788-798.
• Home Care Assistance. (n.d.). In-Home Care for Seniors with Cognitive Decline. Retrieved from https://homecareassistance.com/cognitive-therapeutics-methods
• Verghese, J., Lipton, R. B., Katz, M. J., Hall, C. B., Derby, C. A., Kuslansky, G., ... & Buschke, H. (2003). Leisure Activities and the Risk of Dementia in the Elderly. The New England Journal of Medicine, 348(25), 2508-2516.
• Schulz, R., & Sherwood, P. R. (2008). Physical and Mental Health Effects of Family Caregiving. The American Journal of Nursing, 108(9 Suppl), 23-27.
• National Institute on Aging. (2021). Alzheimer's Caregiving Tips: Home Safety. Retrieved from https://www.nia.nih.gov/health/alzheimers-caregiving-tips-home-safety
• Brodaty, H., & Donkin, M. (2009). Family Caregivers of People with Dementia. Dialogues in Clinical Neuroscience, 11(2), 217-228.

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“I Promised My Parents I'd Never Put Them in a Nursing Home”

Unrealistic promises complicate caregiving, ditch the guilt about senior care decisions, finding the right nursing home can make the decision easier, caregiving doesn’t end after nursing home placement, recent questions, popular questions, related questions.

Hartford Foundation: As 95% of Older Adults Seek to Age in Place, 60% Express Concerns About Nursing Home Quality

Of an estimated 36 million Americans with a family member or friend in a nursing home, only 37% say their loved one is receiving high-quality care. And political affiliation aside, older adults want public policies that support and improve quality care.

That’s according to a study issued by The John A. Hartford Foundation. Based on a survey conducted on behalf of the foundation, only about half of this population says nursing homes are the safest place for their loved ones.

Meanwhile, improving the quality of nursing homes earned bipartisan support among survey respondents, with 62% of Republicans in support, 68% of Democrats, and 65% independents or those with other political affiliation, agreeing on the need for improved quality care.

The survey was conducted between April 17 to May 9, 2024. Of 5,023 adults aged 18 and over, 2,516 were aged 65 and older.

An overwhelming majority, 95%, of respondents said they want to age in place, while 60% expressed concern about receiving poor-quality care, 60% were worried about losing their independence, and 52% felt they would be mistreated or disrespected in a nursing home setting.

“These concerns about long-term care facilities reflect the broader problem of lack of trust in the motivations of our health care system: 81% of adults of all ages and political persuasions agree, ‘the health care system is more concerned with making money than providing good quality care,’” researchers found.

Those in nursing homes need help navigating a plethora of insurance plans as well, according to the survey. About 62% of older adults agree health insurance plans offer too many confusing choices. Medicare coverage in particular is misunderstood, with 45% of older adults mistakenly believing Medicare would cover a long-term stay in a nursing home.

“One-third (34%) feel like dealing with the health care system ‘has become my part-time job,’ and 31% say, ‘I need someone who can help me navigate and coordinate my health care and health insurance.’ Not surprisingly, those with greater health needs, functional limitations, and lower financial resources are in even greater need of trustworthy guidance,” some survey respondents said.

The Foundation came up with five key recommendations to improve health care for older adults based on survey findings, with nursing homes popping up again when it comes to support of a national master plan for aging.

Specifically, financing long-term care and reforming nursing homes was listed, including systems to provide home health care rather than in acute and congregate settings.

Other recommendations included promoting age-friendly care that would help older adults maintain their health and independence; pursuing scientific breakthroughs to bring an end to diseases like Alzheimer’s; address social isolation among older adults; and assist family caregivers with resources and flexibility to take paid leave.

“Better federal and state policies can encourage the development of age-friendly health systems that focus on improving patients’ well-being and quality of life,” said Terry Fulmer, president of The John A. Hartford Foundation. “Policies could include new options for affording long-term care insurance and developing a federal strategy to ensure disadvantaged populations are prioritized in a national strategy for age-friendly care.”

Ken Dychtwald, founder and CEO of Age Wave, said in the study that the sector is at a “unique crossroads,” with the possibility that America’s health care system will meet older adults’ expectations while still being practical and at a lower cost.

“Older adults deserve health care partners who understand what they are going through, have the skills to most effectively support their patients and act on what their customers want,” said Dychtwald.

Consumer expectations are top of mind for nursing home operators as well, with Principle LTC among others saying that it’s one of the sector’s top priorities for future success.

“I think we need to get more granular and look at how we approach customer service training and set expectations,” said Nancy Koha, chief strategy officer at Principle. “I don’t think we can clone ourselves yet to be there 24/7 for people, but how do we meet this need of instant gratification?”

It’s one of the biggest challenges and is something residents want, their families and even staff and leaders. Physician practices, for one, have concierge options to help meet those on-call needs. It folds into what residents and loved ones consider care quality.

“Today’s consumer doesn’t just want an experience, they want this concierge level of care. I think the hardest part about this concierge level of care is this need for instant gratification,” she said.

Companies featured in this article:

Age Wave , John A. Hartford Foundation , Principle LTC

Amy Stulick

A Buffalo transplant living in LA, Amy has worked as a business journalist for more than two years and has been in the profession for seven-plus. She is an avid (sometimes poolside) science fiction reader, nature lover and roller derby novice.

Contact: [email protected] , 312-967-0762

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The Manor House Nursing Home

Burton Manor Road, Hyde Lea, Stafford, Staffordshire, ST18 9AT (01785) 250600

Provided and run by: Hyde Lea Nursing Homes Limited

Report from 16 April 2024 assessment

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Shared direction and culture, capable, compassionate and inclusive leaders, freedom to speak up, workforce equality, diversity and inclusion, governance, management and sustainability, partnerships and communities, learning, improvement and innovation.

We assessed a limited number of quality statements in the well led key question and found areas of good practice. However, improvements were identified to auditing systems, such as health and safety checks and care plan audits. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. The manager responded to our feedback and introduced new quality audits to monitor health and safety checks and review care plans. We will review the success of these new systems in the next assessment. Staff told us they felt supported by the management team, and they felt they worked as a team in order to promote people’s health and wellbeing. Staff told us the new manager was approachable and led by example. The manager told us they were working closely with health and social care partners to continually improve the care and support provided to people.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores .

Staff told us they understood the providers direction and they felt supported within their roles. One staff member told us, “I feel really well supported. The management have been there for me. We share ideas, we help each other.” Another staff member told us, “Morale amongst staff was a bit low but it has come back now. We are all raring to go and want to get the place back up to where it should be. We all work together, we support each other.”

The provider shared their statement of purpose and action plans. They had recently experienced periods of change in the management team and had received concerns from visiting professionals. A relatives meeting was held during this assessment to review the concerns and to share the provider's future plans for the service. This demonstrated the provider used an open culture to discuss concerns and be receptive to feedback.

Staff told us the manager led by example and provided support when needed. One staff member said, “It is easy to approach [the manager] if I have concerns. If I need anything, I just pop up to the office. [The manager] will come and ask me if I'm OK and ask if there's anything they need to know.” Another staff member told us, “I do feel well supported by the new manager. They are approachable and I would be confident that they would address any concerns."

The provider was open about things which had gone wrong such as concerns raised from visiting professionals and incidents involving people. They shared their action plans and told us about the steps they had taken to reduce the risks to people. Minutes of meetings showed how risk were openly discussed and actions were recorded to reduce the risk and improve the quality of care provided to people. The manager understood the duty of candour and told us about the importance of being open and honest.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff were very knowledgeable about their roles. They took responsibility and were accountable for their actions. However, we found gaps in recordings and staff had not always followed the care plan when supporting people. The manager told us how they had addressed these concerns with the care staff and implemented new auditing systems.

Some quality audits were taking place, although these had not always identified the discrepancies found during this assessment. Care plan audits had not always identified the outdated information found in care plans. Health and safety audits required improving to address the gaps in health and safety monitoring. The manager responded to all of our feedback and introduced new auditing systems.

Relatives told us the provider worked in partnership and kept them up to date with changes. One relative said, “[My family member] has CPN visits. The provider stays in contact with me.” CPN’s are Community psychiatric nurses who can help support people experiencing mental health concerns. Another relative told us, “There’s organised meetings if I chose to attend. We’ve got a talk about dementia coming up.” An additional relative told us, “Other medical professionals are involved in [my family member's] care when they need to be. I’ve no complaints, I would complain if I needed to, but I don’t need to.”

Staff told us they work alongside visiting professionals. One staff member told us how they had benefitted from a recent training course with an external dementia specialist who was working with the provider to promote awareness. Other staff told us about how the provider worked with other health professionals such as nurses and GPs.

Visiting professionals shared their concerns over how care was monitored and managed. During this assessment visiting professionals met with us and the provider. They confirmed the provider was working with them to resolve the concerns and there was improvement identified. However, further work was ongoing.

Care records showed joint working with other professionals such as GP, tissue viability nurses, opticians, and physiotherapists. We observed the provider working with other professionals to act on the concerns which had been raised and improve the care and support provided to people.

We did not look at Learning, improvement and innovation during this assessment. The score for this quality statement is based on the previous rating for Well-led.

State disputes Auditor’s report on nursing home inspections

CEDAR RAPIDS, Iowa (KCRG) - Governor Kim Reynolds’ administration called a report by the State Auditor on nursing home inspections “inaccurate, incomplete, and confusing.”

That report said Iowa was failing to meet federal standards from the Centers for Medicaid and Medicare Services for the frequency of inspections and staffing levels.

In response, the Iowa Department of Inspections and Appeals accused the Auditor of misleading Iowans with incorrect or outdated data.

“The auditor’s report is inaccurate, incomplete, and confusing,” DIAL spokesperson Stefanie Bond said in a statement.

The DIAL said the Auditor’s Office never contacted its staff for information and instead relied on outdated data to make its report. That report found that, as of June 1st, Iowa averaged 17.1 months between inspections, above the CMS mandate of 12.9 months with no facility going more than 15.9 months between inspections.

DIAL noted the federal fiscal year runs through September and that it’s current data shows a 12.75 month average between inspections and 99% of facilities complying with the 15.9-month inspection frequency.

CMS will release its own findings of state agencies wonce the federal fiscal year ends at the end of September.

Copyright 2024 KCRG. All rights reserved.

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Work from Home and Disability Employment

There has been a dramatic rise in disability employment in the US since the pandemic, a pattern mirrored in other countries as well. A similar increase is not found for any other major gender, race, age or education demographic. At the same time, work from home has risen four-fold. This paper asks whether the two are causally related. Analyzing CPS and ACS microdata, we find the increase in disability employment is concentrated in occupations with high levels of working from home. Controlling for compositional changes and labor market tightness, we estimate that a 1 percentage point increase in work from home increases full-time employment by 1.1% for individuals with a physical disability. A back of the envelope calculation reveals that the post pandemic increase in working from home explains 80% of the rise in full-time employment. Wage data suggests that WFH increased the supply of workers with a disability, likely by reducing commuting costs and enabling better control of working conditions.

Funding to conduct the Survey of Working Arrangements and Attitudes was generously provided by the Templeton World Charity Foundation, Smith Richardson Foundation, Stanford University, Chicago Booth School of Business, Asociacion Mexicana de Cultura A.C., Stanford Institute for Human-Centered Artificial Intelligence, Toulouse Network for Information Technology, the MIT Mobility Initiative, and the Hoover Institution. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

I worked for McKinsey and company as a management consultant from 2001-2002. I have not received any funding from them after that time.

I am part of the Toulouse Network for Information Technology, which carries out research on IT and productivity. From this network I receive an annual honorarium, which is funded by Microsoft.

I do occasional consulting on management practices for government and policy agencies, like the Canadian Government, the World Bank, the European Union, the British Government, and the European Bank of Reconstruction and Development.

I produced a report in 2008 for the World Economic Forum on management practices in private equity for which I received an honorarium.

I am a paid speaker at corporate events at which I discuss among other things working from home, management practices and policy uncertainty.

MARC RIS BibTeΧ

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Nursing homes body reveals almost 60% are concerned about availability of places

Tadhg Daly, CEO of Nursing Homes Ireland, said: 'This is not just a healthcare issue; it is a challenge for society as a whole.' Photo: Gareth Chaney/Collins

Nearly six in 10 people are very concerned about a lack of nursing homes in their area, with rural areas taking the brunt of recent closures, the sector's representative body has said.

Last year 10 nursing homes closed and seven more so far this year among “at least 77” closures since 2018, Nursing Homes Ireland (NHI) said.

“Most of these closures have occurred in rural areas, deepening concerns over the availability of local care,” it warned.

Research, commissioned by NHI, showed nearly six in 10 people are either very or extremely concerned their relatives may not be able to find a place in a local nursing home.

NHI chief executive Tadhg Daly pointed to the growing number of older people in Ireland as a key factor in this debate. 

“This is not just a healthcare issue; it is a challenge for society as a whole,” he said. “Our ageing population is increasing rapidly, and we should be celebrating this fact. However, if we don't act now, the consequences will be profound.” 

Nursing homes should be a vital part of communities and “planning now will prevent heartbreak later", he said.

Speaking ahead of the NHI national conference which opens on Thursday, he said nursing home owners will come together to discuss the crisis.

“We are calling on policymakers, government officials, and the entire healthcare sector to meet the challenges of caring, together. The projected growth in the number of older people in Ireland means we cannot afford to delay,” he urged.

What's your view on this issue?

You can tell us here

The survey of 1,000 people was carried out last month. Among them, 57% are concerned, 26% extremely concerned and 31% very concerned at gaps in nursing home provision in their areas.

People aged over 40 were more likely to be very or extremely concerned, the survey by Coyne Research found.

Almost four in five of respondents agreed additional funding through the Fair Deal scheme is needed to improve working conditions for private nursing home staff.

Asked whether nursing home care is adequately funded by the State, 15% strongly disagreed that it is and 32% disagreed, coming to a combined 47% with reservations.

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Appropriate leadership in nursing home care: a narrative review

Nick zonneveld.

1 Tilburg University, TIAS School for Business and Society, Tilburg, The Netherlands, and Vilans, National Centre of Expertise in Long Term Care, Utrecht, The Netherlands

Carina Pittens

2 Vrije Universiteit, Athena Institute, Amsterdam, The Netherlands

Mirella Minkman

3 Tilburg University, TIAS School for Business and Society, Tilburg, The Netherlands, and Vilans, National Centre of Expertise in Long Term Care, Utrecht, The Netherlands

The purpose of this paper is to synthesize the existing evidence on leadership that best matches nursing home care, with a focus on behaviors, effects and influencing factors.

Design/methodology/approach

A narrative review was performed in three steps: the establishment of scope, systematic search in five databases and assessment and analysis of the literature identified.

A total of 44 articles were included in the review. The results of the study imply that a stronger focus on leadership behaviors related to the specific context rather than leadership styles could be of added value in nursing home care.

Research limitations/implications

Only articles applicable to nursing home care were included. The definition of “nursing home care” may differ between countries. This study only focused on the academic literature. Future research should focus on strategies and methods for the translation of leadership into behavior in practice.

Practical implications

A broader and more conceptual perspective on leadership in nursing homes – in which leadership is seen as an attribute of all employees and enacted in multiple layers of the organization – could support leadership practice.

Originality/value

Leadership is considered an important element in the delivery of good quality nursing home care. This study provides insight into leadership behaviors and influencing contextual factors specifically in nursing homes.

1. Background

Leadership is seen as essential for the creation of cultural and structural change within organizations and the delivery of good quality nursing home care ( Anderson et al. , 2005 ; Martin and Learmonth, 2012 ). Various studies confirm that leadership affects e.g. business management, information flows, health-related quality indicators, long-term vision, organizational structure, organizational culture, work environment and quality of care in nursing homes ( Anderson et al. , 2005 ; Castle and Decker, 2011 ; Cummings et al. , 2010 ; Jeon et al. , 2015 ). Therefore, more insight is needed into how leadership should look to contribute to organizational and cultural change in nursing home care.

Leadership can be defined as “a process whereby individual influences a group of individuals to achieve a common goal” ( Hunt, 2004 , p. 3). Based on a review of leadership literature, Hunt (2004) distinguishes four common features of leadership. Leadership: is a process, involves influence, occurs in a group context and involves goal attainment. Leadership theory still divides leadership styles into two main groups: relationship-oriented leadership styles and task-oriented leadership styles. While relationship-oriented leadership focuses on individual persons and relationships, task-oriented leadership aims at the accomplishment of tasks. This division could also be interpreted as transformational leadership and transactional leadership ( Avolio et al. , 1999 ). Transformational leadership is reflected in a process, in which a leader connects with his/her followers, with the aim of increasing intrinsic motivation to enhance performance. The driving force is a shared vision. Transactional leadership is a more top-down style, focusing on transactions between the leader and followers. There are clear structures, rules and procedures and the extrinsic motivation of employees is addressed ( Avolio et al. , 1999 ). An example of transactional leadership is giving a personal reward for employees that achieve a certain goal, like a financial bonus. In our study, the two main streams of transformational and transactional leadership are used as an ordering framework, supplemented with a contingency approach category: context-dependent leadership styles. These styles assume that there is no universal leadership style and that different contexts and circumstances require different leadership styles ( Northouse, 2018 ).

Various publications have been written about leadership in nursing home care. In most of these studies relational and transformative-related leadership styles are considered to be most appropriate in a nursing home and aged care ( Anderson et al. , 2005 ; Corazzini et al. , 2015 ; Jeon et al. , 2015 ). The focus of most studies is the relationship between particular leadership styles and desired outcomes rather than understanding the behaviors and context behind them. However, as leadership is a process that takes place between people ( Hunt, 2004 ), it consists of many components and influencing factors. It could also take place at multiple places in an organization, both formally and informally. The relationship between how leadership is executed and the outcomes achieved are, therefore, not simple or linear ( Northouse, 2018 ). Therefore, more in-depth knowledge is required regarding leadership behaviors, the effects and the factors influencing them.

This study aims to provide a deeper understanding of what leadership is appropriate in nursing home care, also considering the changing context. To this end, various leadership behaviors, their effects and their influencing factors are examined by performing a narrative literature review with a systematic search.

The objective of this study is to synthesize the existing evidence on leadership that best matches nursing home care, with a focus on behaviors, effects and influencing factors. A narrative review with a systematic search was conducted, drawing on the principles of hermeneutic review ( Boell and Cecez-Kecmanovic, 2014 ). A hermeneutic review has two main characteristics:

• accessing and interpreting the literature and
• developing an argument.

The literature search is not only systematic but also flexible and iterative. As the identified literature increases, initial insights and ideas arise and less relevant literature could be rejected through progressive focus. It is argued elsewhere that a narrative review like a hermeneutic review should be the method of choice for interpreting a large and diverse set of literature in which authors have approached the topic differently ( Greenhalgh et al. , 2018 ), as is the objective of our literature review. The review was executed in three steps: definition of scope, systematic search and assessment and analysis of the literature identified. To structure these three steps, a search protocol was developed beforehand.

2.1. Step 1: Establishment of scope

Definition of the search area included the formulation of a set of inclusion criteria. Manuscripts were included if they:

• studied leadership;
• targeted long-term care, nursing home/facility care or elderly care and were thereby applicable to the current nursing home care context;
• behavioral characteristics of leadership;
• effects of leadership; and/or
• factors influencing leadership;
• were published between 2007 and December 2019 (because of the rapidly changing context);
• were written in English; and
• presented research findings of empirical work or reviews.

The search terms were developed through an iterative process in which three researchers were involved. Based on the two main elements of the study objectives – leadership and nursing home care – multiple search terms and combinations were explored in two databases (Pubmed/Medline and EBSCO).

2.2. Step 2: Systematic search

Using the terms described, systematic searches were performed in the PubMed/Medline, Cochrane, Cinahl, PsycInfo and Google Scholar databases. The snowballing technique was also applied: i.e. the reference lists of all articles included were studied to identify any additional relevant literature. After identifying all potentially relevant literature, assessment and analysis of the articles took place.

2.3. Step 3: Assessment and analysis of the literature identified

Assessment and analysis of the literature took place in three steps: the articles were screened based on the title, abstract and full-text to determine inclusion, data extraction took place and analysis was carried out on the articles that had been included.

• Screening on the title, abstract and full-text: All titles and abstracts were screened independently by two researchers to decide whether articles met the inclusion criteria. If the two researchers assessed the article differently, a third researcher was consulted. The full-text of the selected articles was then independently assessed for eligibility by two researchers. Again, a third researcher was consulted if there was any disagreement. For this, the principles of the hermeneutic review were applied, meaning that the inclusion of articles in a later stage (for instance, full-text screening) was stricter due to progressive insights.
• Data extraction: Two types of data were extracted from the articles. First, for each article the author(s), year of publication, journal, title, country, study design and applied methods, sector and organizational level were noted. Second, the main findings of the articles were extracted. The data extraction took place by two researchers, supervised by a third researcher. A fourth researcher was consulted if there was any disagreement.
• Analysis: Descriptive analysis was chosen, as a large and diverse set of articles was included in which leadership was approached and studied differently. As the aim was to build an understanding of leadership, the analysis focused on interpreting the findings of the articles included. Reflection on the content analysis took place with a fourth researcher.

The systematic database search resulted in the identification of 2,332 scientific articles. After removal of duplicates, 2,031 records were screened on title and abstract, based on the formulated inclusion criteria. After this screening 76 scientific articles remained for full-text assessment. During the full-text screening, 36 papers were excluded due to the following reasons: no focus on leadership ( n  =   20), not applicable to the nursing home care context ( n  =   3), leadership only focuses on external stakeholders ( n  =   2), articles report only opinions or vision ( n  =   6), no full text available ( n =  3) and no focus on the interaction between leaders and professionals ( n  =   2). As a result of the “snowballing” technique, 3 extra scientific articles were included. This resulted in a total of 44 included articles. Figure 1 shows the PRISMA flow chart, which displays the systematic literature search process. Table 1 presents the characteristics of the articles, including an overview of study design: 17 qualitative, 16 quantitative, 4 mixed methods and 7 (systematic) reviews were included.

PRISMA flow chart

Characteristics of the articles included

3.1. Leadership behaviors

The articles included in this review describe many sorts of leadership behaviors. In most articles, the studied set of leadership behaviors is given a name/title/term such as “partnered leadership,” “connective leadership” and “adaptive leadership.” In the articles, they are often connected to one of the main leadership styles. Descriptions of leadership behaviors identified are, therefore, distributed over three main categories: relationship-oriented leadership, task-oriented leadership and context-dependent leadership.

Especially more recent articles move away from leadership styles and focus more on behaviors essential for new developments in nursing homes. In the articles of Brodtkorb et al. (2019) and Backman et al. (2018) , important leadership characteristics were identified to support the implementation of person-centered care. Havig and Hollister (2018) focused on the interplay of independent workgroups (resembling self-organization) and appropriate supportive leadership.

3.1.1. Relationship-oriented leadership behavior.

In total, 15 different sorts of leaderships related to relationship-oriented leadership were identified in 34 articles. Transformational leadership was studied the most ( n  =   16), followed by relational leadership ( n  =   7) and the resonant, coaching, consensus and consultative autocratic behavioral styles ( n  =   3). Although “partnered leadership” ( Jennings et al. , 2011 ; Leutz et al. , 2010 ), “individualized consideration” ( Cummings et al. , 2010 ), “authentic leadership” ( Hakanson et al. , 2014 ) and “connective leadership” ( Jennings et al. , 2011 ) were also mentioned as research objectives, no outcomes regarding these behaviors were given in the articles.

When looking more closely at behaviors, the leadership types identified shows a lot of overlap. In relationship-oriented leadership behaviors identified, leaders focus on relationships, using emotional skills such as listening and empathy, to increase the involvement of employees ( Cummings et al. , 2008 ; Forbes-Thompson et al. , 2007 ; Havig et al. , 2011 ; Havig et al. , 2011 ; Jeon et al. , 2015 ). As Havig et al. (2011) describe: “relationship-oriented style constitutes the behaviors of supporting […], developing […] and recognizing” ( Havig et al. , 2011 , p. 2). Transformational leadership aims to create awareness and involvement of employees in line with the objectives of the organization ( Nielsen et al. , 2010 ).

3.1.2. Task-oriented leadership behaviors.

Task-oriented leadership behaviors were studied less extensively. Furthermore, they were often contrasted with relationship-oriented leadership behaviors. In total 9 task-oriented types of leadership were mentioned as study objectives in 9 of the articles included in the review. In most of the articles, no specific characteristics were described.

The similarity between task-oriented and transactional leadership behavior is that it is rational, concise and business-like. Task-oriented leadership deals with the management of tasks and activities (who does what, when and how), distribution of roles, objectives, monitoring and results ( Havig et al. , 2011 ; Havig et al. , 2011 ). Transactional leadership takes transactions between leaders and employees as a starting point ( Cummings et al. , 2010 ). In terms of behavior, this is reflected in rewarding and “punishing” employees. “Shareholder management” is characterized by behavior in which minimal attention is paid to the development of relationships between people ( Havig et al. , 2011 ). Employees work relatively autonomously, there is not much communication and decisions are made centrally. Autocratic leaders also make their own decision, but their employees face a relatively low amount of autonomy ( Castle and Decker, 2011 ; Donoghue and Castle, 2009 ; Havig et al. , 2011 ).

3.1.3. Context-dependent leadership behaviors.

Although the studies in this review focus predominantly on relationship-oriented leadership behaviors, the literature also recommends interpreting with caution. Various studies emphasize that leadership is a complex phenomenon that depends on situations and individuals ( Jennings et al. , 2011 ). Some of the articles conclude that a combination of leadership behaviors is needed. Havig et al. (2011) conclude that a combination of both relationship-oriented and task-oriented leadership behaviors is preferred in their study of job satisfaction in nursing homes ( Havig et al. , 2011 ). Nursing homes with a more hierarchical structure and more mutual interdependence could benefit from task-oriented leadership and vice versa. The authors conclude that leadership is context-dependent. Jennings et al. (2011) state:

The strongest statement that can be made based on empirical studies is that it is unwise to view transformational leadership as a preferred style, particularly when this style is assessed independently of other leadership styles and organizational variables ( Jennings et al. , 2011 , p. 15).

Some leadership behaviors identified in this review embrace this context-dependency and represent a combination of leadership behaviors. Lynch et al. (2011) describe the application of situational leadership to residential care. This is characterized by multiple behaviors of a leader, depending on the situation and the individual. Corazzini and colleagues focus on “adaptive leadership,” which makes a distinction between technical and adaptive challenges ( Corazzini et al. , 2015 ; Corazzini and Anderson, 2013 ). In this context, technical challenges refer to issues that can be easily defined and solved with the appropriate expertise or resources. Adaptive challenges, on the other hand, require new and innovative solutions which may also require a change in values or attitudes. Issues often include both technical and adaptive challenges, in which different leadership behaviors are needed ( Corazzini et al. , 2015 ; Corazzini and Anderson, 2013 ).

Both situational and adaptive leadership is built on the belief that appropriate leadership behaviors should be chosen based on situation and context ( Corazzini and Anderson, 2013 ; Lynch et al. , 2011 , 2018 ). Situational leaders exhibit leadership behavior, which fits with a particular situation and adapts this behavior accordingly to achieve results in a planned way. Central to adaptive leadership, which has roots in complexity theory, is the belief that there are no fixed solutions for complex issues. The behavior of adaptive leaders can, therefore, be characterized as highly flexible and adaptive, to cope with (sudden) changes and developments in complex environments ( Table 2 ).

Leadership styles and their associated characteristics and behaviors

3.2. Reported effects of leadership

In 38 articles effects of leadership were described. The effects of leadership were measured quantitatively in 15 of the articles identified. In 4 articles effects were studied using mixed-methods, in 13 articles effects were measured using qualitative methods and effects were described in 6 reviews. The described effects in the qualitative articles are less “hard” and were not taken into consideration in the table. Reported effects can be separated into five categories: the effects of leadership on:

• quality of care;
• quality of life;
• person-centered care; and
• innovation processes.

Table 3 presents the effects studied in these articles.

Reported effects of leadership

Most studies report that relationship-oriented leadership has a positive impact on employees. Relationship-oriented leadership leads to higher job satisfaction ( Cummings et al. , 2010 ; Donoghue and Castle, 2009 ; Havig et al. , 2011 ; Nielsen et al. , 2010 ), a better relationship with work (for example, a higher organizational commitment) ( Cummings et al. , 2010 ; Donoghue and Castle, 2009 ; Lundgren et al. , 2016 ; Nielsen et al. , 2010 ), higher productivity and effectiveness ( Buljac-Samardzic and van Woerkom, 2015 ; Cummings et al. , 2010 ) and more empowerment and development opportunities ( Cummings et al. , 2014 , 2010 ; Lundgren et al. , 2016 ; Nielsen et al. , 2008 ). Among the articles is one systematic review ( Cummings et al. , 2010 ), in which 53 articles are studied. This study concludes that relationship-oriented leadership is more likely to have positive effects on employees.

In 11 of the articles, the relationship between leadership and quality of care was studied. In these articles, different effects were observed. In four articles no effects were found ( Jeon et al. , 2015 ; Marotta, 2010 ; Olinger, 2010 ; Westerberg and Tafvelin, 2014 ). Four papers conclude that relationship-oriented leadership results in a higher quality of care ( Castle and Decker, 2011 ; Harvath et al. , 2008 ; McKinney et al. , 2016 ; Westerberg and Tafvelin, 2014 ), while in one article it is concluded that a combination of task-oriented and relationship-oriented leadership leads to a higher quality of care (with the emphasis on task-oriented leadership) ( Jennings et al. , 2011 ). Based on their study in Sweden, Westerberg and Tafvelin (2014) present an indirect positive relationship between transformational leadership and quality of care, via mediating variables such as organizational support, support by experienced colleagues, workload and control ( Westerberg and Tafvelin, 2014 ). In all articles quality of care is either not defined consistently or not defined at all. One article studied the impact of leadership on quality of life in the USA. McKinney et al. (2016) report that consensus leadership behavior is “associated with a lower likelihood of deficiencies for quality of life” ( McKinney et al. , 2016 , p. 230).

Furthermore, in three articles a relationship between leadership and person-centered care is described ( Backman et al. , 2016 ; Brodtkorb et al. , 2019 ; Lynch et al. , 2011 ). Backman et al. (2016) for instance conclude that there is a significant relationship between the leadership behavior (of older managers) and person-centered care and psychosocial climate. In this Swedish study, the most appropriate type of leadership and the associated behavior is not specified. Concerning the implementation of person-centered care, Backman et al. (2016) mention “Person-centered care moderates the relationship between leadership behavior” ( Backman et al. , 2016 , p. 8). The authors conclude that leadership is more important in organizations that offer less person-centered care. In these organizations, leaders need to provide direction toward a more person-centered way of working. In line with this, Brodtkorb et al. (2019) revealed: “a close connection between leadership style [participative leadership] and culture change processes toward PCC” ( Brodtkorb et al. , 2019 , p. 134).

On the other hand, a number of studies present contrasting findings or caveats (weak or even no evidence) with respect to the positive effects of relationship-oriented leadership ( Harvath et al. , 2008 ; Havig et al. , 2011 ; Jennings et al. , 2011 ; Jeon et al. , 2015 ; Marotta, 2010 ; Olinger, 2010 ). In a Norwegian study, Havig et al. (2011) report that task-oriented leadership has a more significant impact on the job satisfaction of employees. Also, Jennings et al. (2011) conclude that there is little empirical evidence to relate impacts to certain leadership because leadership is multidimensional and complex: leaders use combinations of leadership behaviors and styles in practice. Olinger (2010) found no statistical significance for nursing home administrator and nursing director leadership styles on care quality.

3.3. Factors influencing leadership

Out of all articles included in this review, 22 articles describe factors that could influence leadership. The influencing factors were identified at three levels: the leader, the team(s) and the organization. Table 4 presents these factors.

Factors influencing leadership

A number of influencing factors – found in seven articles – can be related to the leader him/herself: personal characteristics of the leader ( Cummings et al. , 2008 , 2014 ; Nielsen and Cleal, 2011 ), leadership competencies ( Cummings et al. , 2008 ), educational activities ( Cummings et al. , 2008 ; Hakanson et al. , 2014 ; Vesterinen et al. , 2009 ) and distance to practice ( Havig and Hollister, 2018 ; Kristiansen et al. , 2016 ). The systematic review by Cummings et al. (2008) provides particular insight into the influence of these factors on relational leadership. Cummings et al. state that the personal characteristics of effective leaders relate to openness, extraversion and management motivation. “Significant positive relationships were reported between the leaders’ motivation and their leadership behaviors.” ( Cummings et al. , 2008 , p. 244). Education of leaders, both in relation to professional knowledge and to leadership skills, is mentioned as a positive influencing factor in three articles ( Cummings et al. , 2008 ; Hakanson et al. , 2014 ; Vesterinen et al. , 2009 ). In a Swedish case study, Hakanson et al. (2014) found that leaders identify their own shortcomings and needs for personal development by following educational activities. The specific content of the different educational activities or programs were not described in the articles. A distance to practice was found to be a constraining factor ( Havig and Hollister, 2018 ; Kristiansen et al. , 2016 ). As illustrated by Havig and Hollister (2018) :

They also spent less time at the ward and did not have the same knowledge about their employees’ work situation as the leaders in the high-quality wards. The result of this lack of leadership was often poor work environments, with interpersonal conflicts and frustration, which distracted the care workers and turned their focus away from their daily work duties and the residents ( Havig and Hollister, 2018 , p. 379).

Ten studies showed that team-related factors could influence leadership:

• turnover and absence ( Cloutier et al. , 2016 ; Havig et al. , 2011 );
• interpersonal relations ( Corazzini et al. , 2015 ; Havig and Hollister, 2018 );
• workload ( Corazzini et al. , 2015 ; Westerberg and Tafvelin, 2014 );
• willingness to be coached ( Cummings et al. , 2014 ; Havig et al. , 2011 );
• employee well-being and satisfaction ( Cummings et al. , 2014 ; Nielsen et al. , 2008 );
• self-efficacy ( Nielsen et al. , 2009 ; Nielsen and Munir, 2009 ); and
• interdependent workgroups ( Havig and Hollister, 2018 ).

Two articles relate a high turnover and/or absence rate of employees to less effective leadership ( Cloutier et al. , 2016 ; Havig et al. , 2011 ). In a Western Canadian case study, Cloutier et al. (2016) report that “With greater staff mobility and change, the leadership had less knowledge of their staff to mobilize existing skill sets, use the expertise and build cohesion” ( Cloutier et al. , 2016 , p. 12). Close interpersonal relations – staff/staff, leader/staff and staff/resident – were found to be positively related to leadership ( Corazzini et al. , 2015 ; Havig and Hollister, 2018 ). In turn, a high workload was negatively related ( Corazzini et al. , 2015 ; Westerberg and Tafvelin, 2014 ). Also, the (un)willingness of teams to be coached was mentioned as an influencing factor ( Cummings et al. , 2014 ; Nielsen et al. , 2008 ). Cummings et al. illustrate this as follows:

“Some managers reported out that some of their staff have little interest in learning new things and updating their skills and knowledge,” as per the following quote: “They just want to do their job and go home.” […] A manager, who considered coaching uninterested staff to be undesirable, reported: “Not wanting to rock the boat (don’t have time to risk losing that staff)” ( Cummings et al. , 2014 , p. 205).

Furthermore, employee well-being and satisfaction were stated as potential influencers of leadership. Although there is limited evidence of the direct relationship between leadership behavior and well-being ( Nielsen et al. , 2008 ), two articles mention that a higher level of job satisfaction corresponds to more effective leadership ( Cummings et al. , 2014 ; Nielsen et al. , 2008 ). Finally, Havig and Hollister (2018) found that independent workgroups (or teams) of caregivers, which had their own meetings, reports and administrator, could have a possible influence on nursing home quality. Their analysis revealed that workgroups were fostered by three mediators, namely, psychological ownership, perceived insider status and shared mental models.

In total, 20 articles described factors that influence leadership at an organizational level. The following factors were identified in this category:

• organizational structure ( Corazzini et al. , 2015 ; Cummings et al. , 2008 , 2014 ; Lundgren et al. , 2016 ; Rokstad et al. , 2015 );
• the extent to which person-centered care has been implemented ( Backman et al. , 2016 , 2020 );
• organizational culture ( Ali and Terry, 2017 ; Backman et al. , 2020 ; Corazzini et al. , 2015 ; Havig and Hollister, 2018 ; Jeon et al. , 2010 ; Nielsen et al. , 2008 ; Vesterinen et al. , 2009 );
• the available information and information flow ( Forbes-Thompson et al. , 2007 ; Hakanson et al. , 2014 ; Jeon et al. , 2010 ; Vesterinen et al. , 2009 );
• previous leaders ( Vesterinen et al. , 2009 );
• available budget and time ( Ali and Terry, 2017 ; Cummings et al. , 2014 ; Hakanson et al. , 2014 ; Nielsen et al. , 2010 ; Rokstad et al. , 2015 );
• tasks and responsibilities ( Hakanson et al. , 2014 ; Jeon et al. , 2010 ; Kristiansen et al. , 2016 ; Nielsen et al. , 2008 );
• the leadership team ( Hakanson et al. , 2014 ; Vesterinen et al. , 2009 );
• organizational dynamics and stability ( Jeon et al. , 2010 ; Nielsen et al. , 2010 ; Nielsen and Cleal, 2011 );
• support from superiors ( Jeon et al. , 2010 ; Westerberg and Tafvelin, 2014 ); and
• openness to change and innovations ( Brodtkorb et al. , 2019 ; Jeon et al. , 2010 ; Lynch et al. , 2011 ; Nielsen et al. , 2008 ).

First, the structure of an organization was found to influence the way in which leadership is performed. In bigger organizations, for instance, there is often more distance between managers and the work floor than in smaller organizations and this creates challenges to performing direct, relational leadership ( Lundgren et al. , 2016 ; Rokstad et al. , 2015 ). As Lundgren et al. state:

Physical distance between leaders and subordinates reduces the opportunity for leaders to supervise, organize and optimize nursing assistants’ work situations, which may have negative effects in the field of home help services ( Lundgren et al. , 2016 , p. 51).

In a Finnish qualitative study, Vesterinen et al. (2009) report that organizational culture and information available for employees influence leadership:

The managers said that their leadership style was influenced by the flow of information in the organization. It was difficult to lead others toward a vision when there was a lack of information ( Vesterinen et al. , 2009 , p. 508).

Other influencing factors include tasks and responsibilities of leaders ( Hakanson et al. , 2014 ; Kristiansen et al. , 2016 ) and available budget and time. Although they emphasize that leadership depends on situations and people, Nielsen and Cleal (2011) relate a stable organization (low staff turnover, financially stable, no reorganizations) positively to (transformational) leadership.

4. Discussion

As a result of analysis of the academic literature currently available, the findings of this study provide insight into leadership behaviors, their effects and factors influencing them. When looking into what kind of leadership is considered appropriate in the nursing home care context, also considering its current developments, our analysis does not provide an unambiguous answer. Our review shows that leadership in nursing home care is a complex and multidimensional undertaking, influenced by multiple internal and external factors. On the one hand, there is a tendency toward relationship-oriented and transformational leadership in particular. Our search identified 15 different sorts of leadership related to relational leadership with many reported positive effects on health-care professionals, quality of care, quality of life and person-centered care. However, a diversity of measures was used, with a variety in quality. Both quantitatively and qualitatively observed effects were considered. On the other hand, contrasting findings have also been reported, for example, both positive and negative effects on job satisfaction associated with task-oriented leadership ( Cummings et al. , 2010 ; Havig et al. , 2011 ). Also, various studies emphasized that “good” leadership cannot be achieved by applying only one type of leadership behavior. Both relationship-oriented and task-oriented leadership have resulted in positive effects, as demonstrated by the evaluation of job satisfaction in nursing homes ( Havig et al. , 2011 ). Furthermore, as a broad scope was used to comprehensively identify insights applicable in nursing home care, the studies compared in this review were carried out in different contexts (for example, nursing homes, long-term care, facility care, etc.) in different countries using different methodologies. For example, in the studies included in which a relationship between leadership and quality of care was reported, different definitions of quality of care were used and there was no differentiation between specific aspects of quality of care ( Castle and Decker, 2011 ; Havig et al. , 2011 ; Marotta, 2010 ; McKinney et al. , 2016 ; Olinger, 2010 ; Westerberg and Tafvelin, 2014 ). Therefore, it is also difficult to interpret and compare the results of these studies. This makes it hard to draw any meaningful conclusions about the effects of certain leadership. Another complicating factor in the identification of appropriate leadership is that leadership is a product of multiple influencing factors. Our review identified 22 influencing factors at the individual, team and organizational levels. This shows that leadership in nursing home care is not only complex and multidimensional but may also be influenced by internal and external factors. As a consequence, when looking for appropriate leadership, the answer does not lie in one type of leadership.

This observation is also reflected in some of the articles included in the review. Although a relationship-oriented style was the basis for investigation in most of the studies analyzed, some of them report that certain contexts and situations demand more task-oriented behaviors. Furthermore, literature also shows that the combination of both styles may be appropriate. A balanced mix of leadership styles, for instance, a relationship-oriented focus combined with task-oriented behaviors, is also advocated in other sectors outside nursing home care. Mintzberg (2009) , for example, cites the broad variety of leadership styles in the literature and emphasizes that the application of one style may lead to management that is not in balance ( Mintzberg, 2009 ). Furthermore, in their study on leadership patterns and their effects on employee satisfaction and commitment, Gavan O’Shea et al. (2009) conclude that effective leaders use a combination of styles ( Gavan O’Shea et al. , 2009 ). This was also the conclusion reached by Aarons (2006) specifically with respect to the mental health sector ( Aarons, 2006 ).

While our analysis shows a tendency in favor of combinations of elements from different types of leadership to deal with different situations and contexts, many included studies explore relationships between relational and task-oriented leadership only in a bivariate way. As Cummings et al. (2010) conclude:

In our analyzes, we had simplified the pattern of two approaches to leadership styles and their impact on specific outcomes for nurses, the nursing environment and the nursing workforce. In reality, leadership practices, behaviors and styles and outcomes are not that clean-cut ( Cummings et al. , 2010 , p. 17).

This awareness demonstrates that a greater focus on leadership behaviors in relation to contextual factors rather than leadership styles could provide more valuable insight into appropriate leadership in nursing home care. In most of the literature reviewed, however, leadership behavior is not described or explained precisely. Fortunately, more recent literature is moving away from studying solely leadership styles and is focusing more on appropriate leadership behavior for new developments, like the implementation of Dementia Care Mapping and person-centered care ( Backman et al. , 2020 ; Lynch et al. , 2018 ; Quasdorf and Bartholomeyczik, 2019 ).

Another point worthy of reflection is that the results of our study show a broad variety of leadership terms, styles and names and a large degree of overlap between their characteristics. This is especially the case in the field of relationship-oriented leadership. It is debatable whether these different definitions of leadership really encompass different behaviors or only use different terminology.

Considering that a focus on leadership behaviors could provide more insight into effective leadership in nursing home care, it is interesting to ask what leadership behaviors will be appropriate with respect to the current developments in nursing home care. First of all, the nursing home care sector could be considered as a complex adaptive system (CAS), in which the connected elements of the system evolve and adapt continuously ( Meadows, 2008 ). The current developments, with tendencies toward decentralization, self-organization and person-centered care, are examples of this evolving and adapting system. While the nursing home care sector consists of many different entities and a high level of interactivity, nursing homes can also be considered as systems in which organizational dynamics take place ( Ashmos et al. , 2000 ). The consequence of leadership behavior is that it is important to be aware that employees are part of a complex system, both in the organization and in the health system as a whole. As complexity scientists ( Lichtenstein et al. , 2006 ) reflect: “leadership is a dynamic that transcends the capabilities of individuals alone; it is the product of interaction, tension and exchange rules governing changes in perceptions and understanding.” ( Lichtenstein et al. , 2006 , p. 2). In this complex environment, it is important to reflect continuously and analyze the suitability of leadership behaviors in different contexts and situations. Corazzini et al. (2015) elaborate on this in their study about adaptive leadership and they conclude that problems in nursing homes are mostly complex and cannot be solved by one type of leader.

Furthermore, current developments toward flat organizations, decentralization and self-direction, show a tendency toward more collective responsibility and ownership at all layers of organizations. Most papers included in this review addressed a specific organizational level. A number of studies focus on leadership in middle management ( Buljac-Samardzic and van Woerkom, 2015 ; Corazzini and Anderson, 2013 ; Hakanson et al. , 2014 ; Leutz et al. , 2010 ; Nielsen et al. , 2010 ; Nielsen and Cleal, 2011 ; Oldenhof et al. , 2016 ; Vesterinen et al. , 2009 ) and only one article is specifically taking independent workgroups (teams) into account ( Havig and Hollister, 2018 ). Other articles cover board/management level and some do not focus on a specific organizational level. In the light of current developments in nursing home care, taking new organizational structures with decentralized collective responsibilities such as self-directed teams, into account, a focus on leadership across multiple layers of nursing homes would provide more detailed insights into leadership behaviors and the complex interaction between people and situations. It is striking that the current review did only identify one article that focused specifically on these issues.

4.1. Research limitations and implications

The literature review was carried out in a structured and systematic way. Six systematic reviews were used in this study, which included 255 articles in total (including several studies published before January 1, 2007). This provided a strong theoretical basis, including insights into a broader context. Because the leadership literature is extensive, only articles applicable to nursing home care were included. On the one hand, the current tendencies and insights in leadership literature are well represented in the literature applicable to nursing home care. On the other hand, the leadership literature in this sector is still relatively new. This may yield articles that take an exploratory approach. Also, the definition of “nursing home care” may differ between countries as will the services or care which are captured under this term. Furthermore, relevant insights in nursing home care are often shared in non-academic documents or grey literature. This study only focused on the academic literature. This “publication delay” could explain that literature on relatively new leadership-related tendencies such as self-organization, self-management and autonomous teams, was not available.

The results of this study show that a broad range of leadership behaviors is evident in nursing home care. Further investigation of behaviors that match particular contexts or situations would be relevant. The behaviors identified in this review provide insight into leadership in nursing home care, but more research is needed on how this is reflected in practice. Characteristics such as involvement and appreciation mainly focus on the result of leadership behavior, while more knowledge could be gained about how to actually achieve this. Future research should focus on strategies and methods for the translation of leadership into behavior in practice. Another relevant avenue of research is the impact of cultural aspects on leadership. Research demonstrates that leadership-related culture and values may differ across settings and countries ( Ardichvili and Kuchinke, 2002 ; Chhokar et al. , 2007 ; Hofstede, 2011 ). Examples are power distance, masculinity, uncertainty avoidance and long-term orientation ( Hofstede, 2011 ). These core values could influence leadership approaches and behaviors in practice. Our review includes studies from various, mainly Western, countries such as the USA, Canada, Australia, England and multiple Scandinavian countries. The included articles do not explicitly reflect on the cultural aspects of leadership. More insight into what the exact impact of these aspects is would be relevant. Finally, an interesting research question would be to compare how leadership behavior is perceived by the different people involved. The role of informal leadership and the dynamics in collaborating networks could also be interesting topics for further research.

5. Conclusions

In conclusion, because leadership in nursing home care is multidimensional and influenced by multiple factors, no specific type of leadership can be considered as most appropriate. Furthermore, this review showed a high level of overlap between the behaviors of the many types of leadership presented in the articles included. It is, therefore, questionable whether leadership styles are a useful vocabulary in the debate on leadership in nursing homes. Moreover, the current tendency toward flat organizations, decentralization and self-direction transforms leadership into a more collective undertaking that transcends hierarchy and encompasses behavior, context and people. Tendencies toward networks of collaborating organizations require new leadership competencies that transcend organizational boundaries and interests. Therefore, a stronger focus on leadership behaviors in relationship to specific contexts instead of the application of leadership styles could provide more insight into what is needed when and what works.

The findings of this study show that leadership is a complex and multidimensional phenomenon, which is determined by multiple internal and external factors. Employees of nursing homes have to be aware that the success of leadership is determined by the interplay between behavior and several contextual factors and the various people involved. Furthermore, the study findings suggest focusing more on leadership behaviors instead of styles. Although thinking in leadership styles could be helpful in terms of categorization and framing, a broader and more conceptual perspective on leadership could be helpful in providing more insight into the underlying mechanisms and behaviors that play a role in leadership. First, a broader perspective implies that leadership should be seen as more than merely a function for managers and team leaders ( Martin and Learmonth, 2012 ). It should be constructed as something to be enacted by all employees across an organization. Second, the broader perspective also means that one has to be aware that leadership processes take place at multiple layers in an organization, e.g. in the care setting, in professional interaction or at the board level. Third, people in organizations could benefit from more awareness of their leadership behavior and how this fits with the current context, circumstances and developments.

Acknowledgments

Funding : The research is funded by the Dutch Ministry of Health as part of the W&T Program. The Ministry of Health had no role in the design of the study and collection, analysis and interpretation of data and in writing the manuscript.

Competing interests : The authors declare that they have no competing interests.

Availability of data and materials: The data sets used during the current study are available on request.

• Aarons, G.A. (2006), “ Transformational and transactional leadership: association with attitudes toward evidence-based practice ”, Psychiatric Services , Vol. 57 No. 8 , pp. 1162-1169. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Ali, S. and Terry, L. (2017), “ Exploring senior nurses’ understanding of compassionate leadership in the community ”, British Journal of Community Nursing , Vol. 22 No. 2 , pp. 77-87. [ PubMed ] [ Google Scholar ]
• Anderson, R.A., Ammarell, N., Bailey, D.E., Colon-Emeric, C., Corazzini, K., Lekan-Rutledge, D., Piven, M.L., et al. (2005), “ The power of relationship for high quality long term care ”, Journal of Nursing Care quality , Vol. 20 No. 2 , p. 103. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Ardichvili, A. and Kuchinke, K.P. (2002), “ Leadership styles and cultural values among managers and subordinates: a comparative study of four countries of the former Soviet Union, Germany, and the US ”, Human Resource Development International , Vol. 5 No. 1 , pp. 99-117. [ Google Scholar ]
• Ashmos, D.P., Duchon, D. and McDaniel, R.R. Jr, (2000), “ Organizational responses to complexity: the effect on organizational performance ”, Journal of Organizational Change Management , Vol. 13 No. 6 , pp. 577-595. [ Google Scholar ]
• Astala, L., Roos, M., Harmoinen, M. and Suominen, T. (2017), “ Staff experiences of appreciative management in the institutional care of people with intellectual and developmental disabilities – a cross-sectional study ”, Scandinavian Journal of Caring Sciences , Vol. 31 No. 4 , pp. 930-938. [ PubMed ] [ Google Scholar ]
• Avolio, B.J., Bass, B.M. and Jung, D.I. (1999), “ Re-examining the components of transformational and transactional leadership using the multifactor leadership ”, Journal of Occupational and Organizational Psychology , Vol. 72 No. 4 , pp. 441-462. [ Google Scholar ]
• Backman, A., Sjögren, K., Lövheim, H. and Edvardsson, D. (2018), “ Job strain in nursing homes – Exploring the impact of leadership ”, Journal of Clinical Nursing , Vol. 27 Nos 7/8 , pp. 1552-1560. [ PubMed ] [ Google Scholar ]
• Backman, A., Ahnlund, P., Sjögren, K., Lövheim, H., McGilton, K.S. and Edvardsson, D. (2020), “ Embodying person-centred being and doing: leading towards person-centred care in nursing homes as narrated by managers ”, Journal of Clinical Nursing , Vol. 29 Nos 1/2 , pp. 172-183. [ PubMed ] [ Google Scholar ]
• Backman, A., Sjögren, K., Lindkvist, M., Lövheim, H. and Edvardsson, D. (2016), “ Towards person-centredness in aged care – exploring the impact of leadership ”, Journal of Nursing Management , Vol. 24 No. 6 , pp. 766-774. [ PubMed ] [ Google Scholar ]
• Boell, S.K. and Cecez-Kecmanovic, D. (2014), “ A hermeneutic approach for conducting literature reviews and literature searches ”, Communications of the Association for Information Systems , Vol. 34 No. 1 , p. 12. [ Google Scholar ]
• Brodtkorb, K., Skaar, R. and Slettebø, A. (2019), “ The importance of leadership in innovation processes in nursing homes: an integrative review ”, Nordic Journal of Nursing Research , Vol. 39 No. 3 , pp. 127-136. [ Google Scholar ]
• Buljac-Samardzic, M. and van Woerkom, M. (2015), “ Can managers coach their teams too much? ”, Journal of Managerial Psychology , Vol. 30 No. 3 , pp. 280-296. [ Google Scholar ]
• Castle, N.G. and Decker, F.H. (2011), “ Top management leadership style and quality of care in nursing homes ”, The Gerontologist , Vol. 51 No. 5 , pp. 630-642. [ PubMed ] [ Google Scholar ]
• Chhokar, J.S., Brodbeck, F.C. and House, R.J. (2007), Culture and Leadership across the World: The GLOBE Book of in-Depth Studies of 25 Societies , Routledge. [ Google Scholar ]
• Cloutier, D., Cox, A., Kampen, R., Kobayashi, K., Cook, H., Taylor, D. and Gaspard, G. (2016), “ A tale of two sites: lessons on leadership from the implementation of a long-term care delivery model (CDM) in Western Canada ”, Healthcare , Vol. 4 No. 1 , p. 3. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Corazzini, K.N. and Anderson, R.A. (2013), “ When a situation is ‘not black or white’: using adaptive leadership to address complex challenges in nursing home care ”, p. 9. [ PMC free article ] [ PubMed ]
• Corazzini, K., Twersky, J., White, H.K., Buhr, G.T., McConnell, E.S., Weiner, M. and Colón-Emeric, C.S. (2015), “ Implementing culture change in nursing homes: an adaptive leadership framework ”, The Gerontologist , Vol. 55 No. 4 , pp. 616-627. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Cummings, G., Lee, H., MacGregor, T., Davey, M., Wong, C., Paul, L. and Stafford, E. (2008), “ Factors contributing to nursing leadership: a systematic review ”, Journal of Health Services Research and policy , Vol. 13 No. 4 , pp. 240-248. [ PubMed ] [ Google Scholar ]
• Cummings, G., Mallidou, A.A., Masaoud, E., Kumbamu, A., Schalm, C., Spence Laschinger, H.K. and Estabrooks, C.A. (2014), “ On becoming a coach: a pilot intervention study with managers in long-term care ”, Health Care Management Review , Vol. 39 No. 3 , pp. 198-209. [ PubMed ] [ Google Scholar ]
• Cummings, G.G., MacGregor, T., Davey, M., Lee, H., Wong, C.A., Lo, E., Muise, M., et al. (2010), “ Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review ”, International Journal of Nursing Studies , Vol. 47 No. 3 , pp. 363-385. [ PubMed ] [ Google Scholar ]
• Donoghue, C. and Castle, N.G. (2009), “ Leadership styles of nursing home administrators and their association with staff turnover ”, The Gerontologist , Vol. 49 No. 2 , pp. 166-174. [ PubMed ] [ Google Scholar ]
• Forbes-Thompson, S., Leiker, T. and Bleich, M.R. (2007), “ High-performing and low-performing nursing homes: a view from complexity science ”, Health Care Management Review , Vol. 32 No. 4 , pp. 341-351. [ PubMed ] [ Google Scholar ]
• Gavan O’Shea, P., Foti, R.J., Hauenstein, N.M.A. and Bycio, P. (2009), “ Are the best leaders both transformational and transactional? A pattern-oriented analysis ”, Leadership , Vol. 5 No. 2 , pp. 237-259. [ Google Scholar ]
• Greenhalgh, T., Thorne, S. and Malterud, K. (2018), “ Time to challenge the spurious hierarchy of systematic over narrative reviews? ”, European Journal of Clinical Investigation , Vol. 48 No. 6 . [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hakanson, C., Seiger Cronfalk, B., Henriksen, E., Norberg, A., Ternestedt, B.-M. and Sandberg, J. (2014), “ First-line nursing home managers in Sweden and their views on leadership and palliative care ”, The Open Nursing Journal , Vol. 8 No. 1 , pp. 71-78. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Harvath, T.A., Swafford, K., Smith, K., Miller, L.L., Volpin, M., Sexson, K., White, D., et al. (2008), “ Enhancing nursing leadership in long-term care ”, Research in Gerontological Nursing , Vol. 1 No. 3 , pp. 187-196. [ PubMed ] [ Google Scholar ]
• Havig, A.K. and Hollister, B. (2018), “ How does leadership influence quality of care? Towards a model of leadership and the organization of work in nursing homes ”, Ageing International , Vol. 43 No. 3 , pp. 366-389. [ Google Scholar ]
• Havig, A.K., Skogstad, A., Kjekshus, L.E. and Romøren, T.I. (2011), “ Leadership, staffing and quality of care in nursing homes ”, BMC Health Services Research , Vol. 11 No. 1 , p. 327. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Havig, A.K., Skogstad, A., Veenstra, M. and Romøren, T.I. (2011), “ The effects of leadership and ward factors on job satisfaction in nursing homes: a multilevel approach: leadership and job satisfaction in nursing homes ”, Journal of Clinical Nursing , Vol. 20 Nos 23/24 , pp. 3532-3542. [ PubMed ] [ Google Scholar ]
• Hofstede, G. (2011), “ Dimensionalizing cultures: the hofstede model in context ”, Online Readings in Psychology and Culture , Vol. 2 No. 1 , pp. 2307-0919. [ Google Scholar ]
• Huber, M., Vliet, M. V., Giezenberg, M., Winkens, B., Heerkens, Y., Dagnelie, P.C. and Knottnerus, J.A. (2016), “ Towards a ‘patient-centred’ operationalisation of the new dynamic concept of health: a mixed methods study ”, BMJ Open , Vol. 6 No. 1 , p. e010091. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hunt, J.G.J. (2004), “ What is leadership? ”.
• Jennings, B.M., Disch, J. and Senn, L. (2011), “ Chapter 20. Leadership ”, Vol. 2 , p. 24. [ Google Scholar ]
• Jeon, Y.H., Merlyn, T. and Chenoweth, L. (2010), “ Leadership and management in the aged care sector: a narrative synthesis: leadership and management in aged care ”, Australasian Journal on Ageing , Vol. 29 No. 2 , pp. 54-60. [ PubMed ] [ Google Scholar ]
• Jeon, Y.H., Conway, J., Chenoweth, L., Weise, J., Thomas, T.H. and Williams, A. (2015), “ Validation of a clinical leadership qualities framework for managers in aged care: a Delphi study ”, Journal of Clinical Nursing , Vol. 24 Nos 7/8 , pp. 999-1010. [ PubMed ] [ Google Scholar ]
• Jeon, Y.H., Simpson, J.M., Li, Z., Cunich, M.M., Thomas, T.H., Chenoweth, L. and Kendig, H.L. (2015), “ Cluster randomized controlled trial of an aged care specific leadership and management program to improve work environment, staff turnover, and care quality ”, Journal of the American Medical Directors Association , Vol. 16 No. 7 , pp. 629.e19-629.e28. [ PubMed ] [ Google Scholar ]
• Keisu, B.I., Öhman, A. and Enberg, B. (2018), “ Employee effort–reward balance and first-level manager transformational leadership within elderly care ”, Scandinavian Journal of Caring Sciences , Vol. 32 No. 1 , pp. 407-416. [ PubMed ] [ Google Scholar ]
• Kristiansen, M., Westeren, K.I., Obstfelder, A. and Lotherington, A.T. (2016), “ Coping with increased managerial tasks: tensions and dilemmas in nursing leadership ”, Journal of Research in Nursing , Vol. 21 No. 7 , pp. 492-502. [ Google Scholar ]
• Leutz, W., Bishop, C.E. and Dodson, L. (2010), “ Role for a labor-management partnership in nursing home person-centered care ”, The Gerontologist , Vol. 50 No. 3 , pp. 340-351. [ PubMed ] [ Google Scholar ]
• Lichtenstein, B.B., Uhl-Bien, M., Marion, R., Seers, A., Orton, J.D. and Schreiber, C. (2006), “ Complexity leadership theory: an interactive perspective on leading in complex adaptive systems ”.
• Lundgren, D., Ernsth-Bravell, M. and Kåreholt, I. (2016), “ Leadership and the psychosocial work environment in old age care ”, International Journal of Older People Nursing , Vol. 11 No. 1 , pp. 44-54. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lynch, B.M., McCORMACK, B. and McCANCE, T. (2011), “ Development of a model of situational leadership in residential care for older people: leadership in residential care for older people ”, Journal of Nursing Management , Vol. 19 No. 8 , pp. 1058-1069. [ PubMed ] [ Google Scholar ]
• Lynch, B.M., McCance, T., McCormack, B. and Brown, D. (2018), “ The development of the person-centred situational leadership framework: revealing the being of person-centredness in nursing homes ”, Journal of Clinical Nursing , Vol. 27 Nos 1/2 , pp. 427-440. [ PubMed ] [ Google Scholar ]
• McCormack, B., Dewing, J., Breslin, L., Coyne-Nevin, A., Kennedy, K., Manning, M., Peelo-Kilroe, L., et al. (2010), “ Developing person-centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people ”, International Journal of Older People Nursing , Vol. 5 No. 2 , pp. 93-107. [ PubMed ] [ Google Scholar ]
• McKinney, S.H., Corazzini, K., Anderson, R.A., Sloane, R. and Castle, N.G. (2016), “ Nursing home director of nursing leadership style and director of nursing-sensitive survey deficiencies ”, Health Care Management Review , Vol. 41 No. 3 , pp. 224-232. [ PubMed ] [ Google Scholar ]
• Marotta, J. (2010), “ Leadership, emotional intelligence and quality care in long-term care cacilities ”, PhD Thesis, University of Phoenix. [ Google Scholar ]
• Martin, G.P. and Learmonth, M. (2012), “ A critical account of the rise and spread of ‘leadership’: the case of UK healthcare ”, Social Science and Medicine (1982) , Vol. 74 No. 3 , pp. 281-288. [ PubMed ] [ Google Scholar ]
• Meadows, D.H. (2008), Thinking in Systems: A Primer , Chelsea green publishing. [ Google Scholar ]
• Mintzberg, H. (2009), Managing , Berrett-Koehler Publishers. [ Google Scholar ]
• Nielsen, K. and Cleal, B. (2011), “ Under which conditions do middle managers exhibit transformational leadership behaviors? An experience sampling method study on the predictors of transformational leadership behaviors ”, The Leadership Quarterly , Vol. 22 No. 2 , pp. 344-352. [ Google Scholar ]
• Nielsen, K. and Munir, F. (2009), “ How do transformational leaders influence followers’ affective well-being? Exploring the mediating role of self-efficacy ”, Work and Stress , Vol. 23 No. 4 , pp. 313-329. [ Google Scholar ]
• Nielsen, K., Randall, R. and Christensen, K.B. (2010), “ Does training managers enhance the effects of implementing team-working? A longitudinal, mixed methods field study ”, Human Relations , Vol. 63 No. 11 , pp. 1719-1741. [ Google Scholar ]
• Nielsen, K., Randall, R., Yarker, J. and Brenner, S.-O. (2008), “ The effects of transformational leadership on followers’ perceived work characteristics and psychological well-being: a longitudinal study ”, Work and Stress , Vol. 22 No. 1 , pp. 16-32. [ Google Scholar ]
• Nielsen, K., Yarker, J., Randall, R. and Munir, F. (2009), “ The mediating effects of team and self-efficacy on the relationship between transformational leadership, and job satisfaction and psychological well-being in healthcare professionals: a cross-sectional questionnaire survey ”, International Journal of Nursing Studies , Vol. 46 No. 9 , pp. 1236-1244. [ PubMed ] [ Google Scholar ]
• Northouse, P.G. (2018), Leadership: Theory and Practice , Sage Publications. [ Google Scholar ]
• Oldenhof, L., Stoopendaal, A. and Putters, K. (2016), “ Professional talk: how middle managers frame care workers as Professionals ”, Health Care Analysis , Vol. 24 No. 1 , pp. 47-70. [ PubMed ] [ Google Scholar ]
• Olinger, J. (2010), “ Nursing home leadership styles and performance outcomes: a quantitative study about Leader Relationships ”, PhD Thesis, University of Phoenix. [ Google Scholar ]
• Quasdorf, T. and Bartholomeyczik, S. (2019), “ Influence of leadership on implementing dementia care mapping: a multiple case study ”, Dementia , Vol. 18 No. 6 , pp. 1976-1993. [ PubMed ] [ Google Scholar ]
• Rokstad, A.M.M., Vatne, S., Engedal, K. and Selbaek, G. (2015), “ The role of leadership in the implementation of person-centred care using dementia care mapping: a study in three nursing homes ”, Journal of Nursing Management , Vol. 23 No. 1 , pp. 15-26. [ PubMed ] [ Google Scholar ]
• Vesterinen, S., Isola, A. and Paasivaara, L. (2009), “ Leadership styles of Finnish nurse managers and factors influencing it ”, Journal of Nursing Management , Vol. 17 No. 4 , pp. 503-509. [ PubMed ] [ Google Scholar ]
• Westerberg, K. and Tafvelin, S. (2014), “ The importance of leadership style and psychosocial work environment to staff-assessed quality of care: implications for home help services ”, Health and Social Care in the community , Vol. 22 No. 5 , pp. 461-468. [ PubMed ] [ Google Scholar ]
• White-Chu, E.F., Graves, W.J., Godfrey, S.M., Bonner, A. and Sloane, P. (2009), “ Beyond the medical model: the culture change revolution in long-term care ”, Journal of the American Medical Directors Association , Vol. 10 No. 6 , pp. 370-378. [ PubMed ] [ Google Scholar ]
• World Health Organization (2015), World Report on Ageing and Health , World Health Organization. [ Google Scholar ]
• World Health Organization (2016), Working for Health and Growth: Investing in the Health Workforce .

Almost a century after Virginia Woolf’s ‘A Room of One’s Own’ essay, women are driving the housing market

Priscilla Almodovar is the president and CEO Fannie Mae.

In 1920, women won the right to vote with the adoption of the 19th Amendment to the U.S. Constitution. In 1929, English writer Virginia Woolf published her landmark essay , A Room of One’s Own , which addressed the many injustices women suffered at the time. But it wasn’t until 1974 that the U.S. Congress expanded the Fair Housing Act to outlaw discrimination against women in buying a home. Until then, banks could require women to have a male cosigner to get a mortgage.

Today, single women surpass single men in owning homes—11 million versus 8.3 million, per U.S. Census data. Even in this tough housing market, more women than men (20% versus 16%) seriously considered buying a home in the past year, a Fannie Mae consumer survey found. And years of research show women especially cherish the security of owning the roof over their families’ heads.

Yet, women continue to face disparities in income, savings, and wealth and struggle with down payments. Additionally, more women than men are single parents who shoulder childcare costs or care for aging parents.

Meeting women’s demand for homeownership is an investment in women that benefits families, communities, and economies. For lenders, seeing and serving women homebuyers is an untapped industry growth opportunity.

First, we must demystify—and simplify—the mortgage process, which can be especially daunting for historically overlooked, underserved, and less experienced groups.

Our survey found that 52% of women think it will be difficult to obtain a mortgage and only 35% feel confident going through the process. They’re far from alone—only 45% of all consumers feel confident going through the mortgage process.

Moreover, some 30% of consumers, including women, are unaware of the minimum down payment for a typical mortgage. Others assume the old gold standard of 20% down when 3% to 5% down payments with the right credit and debt-to-income ratio are commonplace. Nearly a third don’t know or greatly over- or underestimate the required minimum credit score. 

Expanding homebuyer education and information would help women and society. But that’s not enough. We need to dig deeper.

For instance, an estimated 50 million people in America are “credit invisible.” Many haven’t interacted with the credit system or have little or no credit files. Yet many may be mortgage creditworthy and not know it—like renters who’ve consistently paid their landlord on time like they would a mortgage or self-employed entrepreneurs with consistent but nontraditional incomes. Many are women who’ve faced gender discrimination.

The good news is that fresh thinking and harnessing data tech and analytics can power lenders to identify and qualify the hidden creditworthy homebuyers. For instance, Fannie Mae is asking our rental property landlords to share their tenants’ timely rent payments with credit agencies, so their credit scores reflect their largest monthly payment. We’re also “teaching” our underwriting system to look at overall monthly cash flows to identify on-time rent payments, as well as nontraditional sources of income (rather than simply paychecks). 

This seems to work. Of the 450,000 renters enrolled in our rent-reporting pilot, two-thirds who started without any credit score gained a credit score of 660 or higher within six months, our lead vendor reports. Those with an existing score boosted it by 35 points on average.

Mortgage innovations can open doors for women homebuyers. Single women are the largest group of apartment renters and outnumber single men in the overall rental market —so factoring in their rents could boost their credit qualifications. Over the past five years, the number of women-owned businesses has grown at nearly double the rate of businesses owned by men . Women business owners without credit scores could thus get a boost when we look at their real cash flow. Late last year, Fannie Mae also provided lenders with an income calculator that simplifies the process of qualifying self-employed borrowers.

Ninety-five years ago, Virginia Woolf made the point that “a woman must have money and a room of her own if she is to write fiction.” She would be pleasantly surprised that today, women having a whole house of their own is not only commonplace but a key driver of the housing market. Making the mortgage process easier and more accessible for women and all homebuyers is in the housing industry’s—and our nation’s—best interest.

More must-read commentary published by  Fortune :

• Inflation, housing, immigration, taxes:  The Harris-Walz economic policy scorecard
• The ‘sustainability recession’  will end soon—and not by choice
• ‘Godmother of AI’ says California’s well-intended  AI bill will harm the U.S. ecosystem
• The most underrated leadership skill, according to  Jake Sullivan

The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of  Fortune .

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Nursing Home Fire in Russia Kills 11

Small privately run facilities are filling a niche in the country, but fires in these homes are common occurrences.

By Anton Troianovski

MOSCOW — Two years ago, a private nursing home opened in a village outside the hardscrabble capital of Russia’s steel industry, Magnitogorsk. The home, a social-media advertisement said, was meant for people “whose own family cannot, for this or that reason, provide the necessary care.”

It was a one-story, log-cabin-style building with an attic.

On Tuesday, it burned down in a fire that killed 11 residents.

“There was no main exit — everything was on fire,” a woman working at the nursing home told a local news outlet , describing how she tried to push residents out through a window. “I started waking, yanking, lugging people.” It was unclear how many people lived in the home.

Local officials expressed shock, while the authorities began an investigation and detained the home’s director. But nursing home fires are a numbingly common occurrence in Russia, where poverty and an aging population have helped spawn a growing industry of cramped and unregulated dormitories for older adults.

And revelations of poor conditions in such homes are provoking uncomfortable introspection in a country where politicians constantly venerate the heroism of past generations.

“There’s a lack of demand in society for quality of life when someone needs care,” said Aleksei Sidnev, chief executive of a high-end Russian chain of retirement homes called Senior Group. “It is believed that old age means you can write yourself off, and you just need someone who can pass you a glass of water.”

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