Date of Award
Spring 2025
Language
English
Embargo Period
3-4-2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
College/School/Department
Department of Public Administration and Policy
Program
Public Administration and Policy
First Advisor
Ashley Fox
Committee Members
Ashley Fox, Gang Chen, Wendy Weller
Keywords
regulation, nursing home, deterrence theory, content analysis, quality of care, institutional theory
Subject Categories
Public Affairs, Public Policy and Public Administration
Abstract
The federal government is responsible for ensuring that nursing homes comply with regulations designed to protect residents from abuse, neglect, and substandard care. To this end, the Centers for Medicare and Medicaid Services (CMS) partners with states to conduct onsite inspections of nursing homes, during which regulators may identify violations. The agency can take one or more actions in response to violations, including imposing civil money penalties (fines), appointing a state monitor, or mandating remedial education for staff. Despite this regulatory framework, the quality of care in nursing homes remains poor, with many facilities failing to protect the well-being of residents. This persistently poor quality in the face of governmental regulations raises questions about the effectiveness of the interventions employed by CMS. My dissertation is an effort to better understand the regulatory framework and its consequences for nursing homes. In the first of three chapters, I find that contributors to regulatory non-compliance include shortages of staff and supplies; issues with organizational culture; and breakdowns in communication. In the second chapter, I find that penalties are effective at deterring future violations but other types of non-monetary actions have limited effect. In the third chapter, my results show that large penalties have the potential unintended effect of jeopardizing the financial stability of nursing homes. Taken together, the three chapters provide insight into the organizational dynamics that drive regulatory non-compliance, and they suggest that while penalties can deter future violations, they should be carefully calibrated to avoid damaging the financial health of facilities.
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Schumacher, Patrick, "A Study of Regulatory Compliance in U.S. Nursing Homes" (2025). Electronic Theses & Dissertations (2024 - present). 115.
https://scholarsarchive.library.albany.edu/etd/115
