Date of Award




Document Type


Degree Name

Doctor of Philosophy (PhD)


Department of Public Administration and Policy

Content Description

1 online resource (xi, 194 pages) : PDF file, illustrations

Dissertation/Thesis Chair

Judith R Saidel

Committee Members

James W Fossett, R. Karl Rethemeyer


Aging, Compliance, Enforcement, Nursing Homes, Regulation, Stakeholder, Nursing homes

Subject Categories

Political Science | Public Administration | Public Health


This dissertation proposes a conceptual framework that integrates stakeholder and compliance theory and employs a multi-method approach to examine the influence of stakeholders, bureaucratic discretion and external environment on nursing home inspections and enforcement. Negative binomial regression analysis was conducted on a population of 655 nursing homes in New York to identify determinants of variation in compliance and enforcement (as measured by deficiency citations). As hypothesized, organizational characteristics (i.e., nursing home bed capacity, sponsorship, occupancy rates and Medicaid revenue) were significant predictors of regulatory compliance and quality of care. Nursing home complaints, the presence of family councils, political party of the state assembly representative and per capita income emerged as key stakeholder and political variables. The effect of the State Health Department regional field offices on deficiencies suggests that bureaucratic discretion, survey inspector experience and other factors related to local management and personnel are crucial to understanding variability in nursing home oversight activities.