Innovation in Nursing Homes: Which Facilities Are the Early Adopters?

Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ 08901, USA.
The Gerontologist (Impact Factor: 3.21). 05/2001; 41(2):161-72. DOI: 10.1093/geront/41.2.161
Source: PubMed


This study examined organizational and market factors associated with nursing homes that are most likely to be early adopters of innovations. Early adopter institutions, defined as the first 20% of facilities to adopt an innovation, are important because they subsequently facilitate the diffusion of innovations to others in the industry.
Two groups of innovations were examined, special care units and subacute care services. I used discrete-time logistic regression analysis and nationally representative data from 13,162 facilities at risk of being early adopters of innovations during twelve 6-month intervals from 1992 to 1997.
Organizational factors that increase the likelihood of early innovation adoption are larger bed size, chain membership, and high levels of private-pay residents. Four market factors that increase the likelihood of early innovation adoption are: a retrospective Medicaid reimbursement methodology, a more competitive environment, higher average income in the county, and a higher number of hospital beds in the county.
This analysis shows that organizational and market characteristics of nursing homes affect their propensity toward early adoption of innovations. Some of the results may be useful for nursing home administrators and policy makers attempting to promote innovation.

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    • "Nursing homes decry emphasis on the negatives of their facilities and the little recognition of the positives. Turnover of nurses, certified nursing assistants, and administrative staff make provision of quality of care and innovation in care extremely difficult (Castle, 2001; Maas, Specht, Buckwalter, Gittler, & Bechen, 2008). It has been especially hard to recruit bachelor-prepared nurses to nursing homes, adding to the difficulty of having nurses adequately prepared to care for older individuals with complex needs in addition to managing a large staff of minimally prepared workers. "
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    • "Castle (2001) examines nursing homes that are pioneer users of new processes and technology since " identifying characteristics associated with this early adoption process could be useful in further facilitating the diffusion of innovations " (Castle 2001, 161). From a sample of more than 13,000 US facilities between 1992 and 1997, the author identifies the first 20 percent of firms to adopt any of 13 innovations, including for example special care units for Alzheimer's disease, AIDS, head trauma or Huntingdon's disease as well as subacute care for physical therapy, cardiac treatment, and dialysis. "
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    • "Second, we were not able to include years prior to 1996 because some variables, such as the classes of psychotropic medications, were not yet reported in the OSCAR database. Facilities that first reported an D-SCU after 1996 are relatively late adopters, and it is difficult to know how the inclusion of earlier adopters would have affected our findings (Castle, 2001). Third, we considered only the introduction of new D-SCUs and did not try to study the effect of D-SCU closings. "
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