All ETDs from UAB

Advisory Committee Chair

Robert Weech-Maldonado

Advisory Committee Members

Rita A Jablonski

Amy Landry

Justin Lord

Ferhat Zengul

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


Alzheimer’s disease special care units (AD SCUs) have been adopted to provide specialized care for people with dementia in nursing homes. However, the effects of environmental and organizational factors on AD SCUs adoption by nursing homes and their influence on nursing homes' organizational performance remains unclear. Guided by Resource Dependence Theory, Donabedian’s Structure-Process-Outcome (SPO) framework and the Resource-Based View of Firms perspective, the purpose of the three papers included in this dissertation was to provide empirical evidence of the contextual and organizational factors that influence AD SCUs adoption among nursing homes and how the adoption of AD SCUs impact nursing homes quality of care and financial performance. This study employed NH-level panel data from 2005 to 2019. The findings of this dissertation suggest that some measures of environmental munificence, complexity, and dynamism were associated with AD SCUs adoption. Specifically, nursing homes operating in more monopolistic markets were more likely to adopt AD SCUs. On the other hand, a higher concentration of minority populations and higher change in the Medicare Advantage penetration rate were negatively associated with AD SCUs adoption. In addition, organizational factors such as size, for-profit status, occupancy rate, and payer mix were significant predictors of AD SCUs adoption. Additionally, better processes and outcomes of care were associated with AD SCUs iv adoption. Further, analysis of financial performance indicated that AD SCUs adoption was marginally significant associated with improved nursing homes' financial performance. Specifically, AD SCUs adoption was associated with higher operating margins among nursing homes. Organizational factors such as nursing home size, for-profit status, occupancy rate, dementia census, percentage of Hispanic residents, and Medicare and Medicaid census were predictors of financial performance. Further, market characteristics such as per capita income, market competition, and Medicare Advantage penetration were also associated with NHs' financial performance. These findings can be used by NHs administrators to make informed decisions when adopting specialized care for people with dementia. Additionally, these results will provide policymakers and nursing home administrators with a better understanding of the relationship between AD SCUs and NHs' quality of care and financial performance.



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