Date of Award


Document Type


Degree Name

Doctor of Health Administration


College of Health Professions

First Advisor

Jillian Harvey

Second Advisor

Walter Jones

Third Advisor

Amy Martel


Policymaking has a long and complex history in long-term care, which is one of the most highly regulated industries in the United States. The Final Rule for Reform of Requirements of Participation (RoP) for Long-Term Care Facilities was published with Phase I of III effective November 26, 2016. A retrospective program evaluation using data from the Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare was conducted of 14,210 SNFs/ NFs. This study used a quantitative approach to determine the impact of the RoP on four quality measures: percentage of long-stay residents who received an antipsychotic, long-stay residents with moderate to severe pain, long-stay residents who were physically restrained, and short-stay residents with pressure ulcers that are new or worsened. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 24. Significant changes were observed in the percentage of each of the four quality measures pre- and post-implementation of the RoP. Logistic models indicate the influence of ownership and location on quality measure percentages RoP. This study adds to existing literature regarding the impact of regulatory stringency on nursing homes and provides important recommendations for policymakers and future research.


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