Factors influencing nursing home accreditation-quality ratings in Korea

Purpose: The purpose of this study is to examine the relationship between the level of competition among nursing homes (NHs) and their geographical locations with government NH accreditation-quality ratings in Korea. We also examined the possible mediating effects of nurse turnover and NH residents’ hospitalization on the relationship. Methods: We used a cross-sectional design in this study. Data accrued using a disproportionately stratified cluster-sampling method in Korea. Independent variables included location and competition among NHs, as measured by the Herfindahl-Hirschman Index. The mediating variables included registered nurse (RN) turnover and hospital admissions from NHs. The dependent variable was the NH accreditation grade, openly published by the Korean National Health Insurance Service. Results: The high turnover of professional RNs results in deteriorated government nursing-home-quality ratings and increased hospital admissions relating to better nursing-home-quality ratings. RN turnover was statistically significant with evaluation grade and admission. Conclusion: This study identified challenges in Korea’s system of public reporting on NH quality. The accreditation system must reflect appropriate, concrete information on RN turnover and hospital admissions so NH residents are managed in a timely manner, avoiding inappropriate hospitalization.