Advisor(s)
Jane Banaszak-Holl
Committee Member(s)
Allyson Hall
Geoffrey Silvera
Jeff Szychowski
School
School of Health Professions
Document Type
Dissertation
Department (new version)
Health Professions
Date of Award
9-11-2025
Degree Name by School
Executive Doctor of Science (DSc) School of Health Professions
Abstract
Approximately 1.3 million people reside in nursing homes/facilities. Annually, this population represents 25% of mortalities in the United States. The enactment of the Patient Self Determination Act (PSDA) required nursing homes/facilities to educate patients, staff, and the community on the right to advance care directives. This study aimed to evaluate the impact of nursing home ownership on the election of ACDs and end-of-life care services by examining how nursing homes ownership in New York, California, and Ohio compared regarding residents' election of ACD and whether there was a variation in the these states. This paper contributes to the literature by evaluating factors predicting variation in the election of ACD and hospice care services, which can impact how regulatory approaches standardized election of ACDs. Design: Explanatory comparative mixed-method design. Setting and Participants: Nursing Home/Facilities and Licensed Nursing Home Administrators (LNHA) across three states, California, New York, and Ohio. Method: Retrospective analysis of the election of ACDs and the clinical characteristics of the nursing home patient based on the Minimum Data Set 2.0 and 3.0. Additionally, the researcher conducted focused interviews with LNHAs to evaluate the influence of ownership on ACDs and end-of-life services. Institutional/regulatory theory may explain the variation in the adoption of advance care planning across the states. Results: The sample comprised 5,512 nursing homes/facilities across three states: New York, California, and Ohio. In 2010, there were 2,781 nursing homes, of which 1,489 were for-profit facilities. By 2018, this number had slightly decreased to 2,631, with 2,148 still being for-profit facilities. Data analysis supported a statistically significant relationship with the election of Do Not Resuscitate with not-for-profit ownership in 2010 in California. LNHA interviews were conducted to provide deeper insights into how nursing home/facility ownership influences the election of advance care directives and end-of-life care services among nursing home/ facility patients. The study revealed state laws as well as ownership does influence the utilization of end-of-life services. Conclusion: Standardization of education for ACDs and end-of-life care will reduce the variability in the election of ACDs across states and healthcare settings; and there remains a need for standardization of end-of-life care.
ProQuest ID
Recommended Citation
Elie, Natasha, "The Impact Of Nursing Home Ownership On The Election Of Advance Care Directives" (2025). All ETDs from UAB. 7448.
https://digitalcommons.library.uab.edu/etd-collection/7448
