Date of Conferral



Doctor of Business Administration (D.B.A.)




David L. Moody


From 2014 to 2015, deficiency fines cost Pennsylvania nursing homes more than $2.5 million. Costs associated with adhering to increased health care regulations can reduce profit and affect the financial sustainability of the nursing home industry. Some nursing home administrators (NHAs) lack successful strategies to improve state and federal regulation compliance and promote financial sustainability. Drucker's management by objectives theory was the conceptual framework for this study. The purpose of this qualitative multiple case study was to explore successful strategies NHAs use to improve state and federal regulation compliance to mitigate deficiencies and derivative fines to promote financial sustainability of nursing homes. NHAs who manage 5-star rated nursing homes within a 100-mile radius of Pittsburgh, Pennsylvania use effective management strategies to mitigate deficiencies and derivative fines to earn a 5-star rating which, helps promote financial sustainability. Data were collected from semistructured face-to-face and telephone interviews with 4 NHAs and from Medicare's Nursing Home Compare website. The data on the website provided information on the 3 domains of health inspections, staffing, and quality measures, that made up the overall star rating of nursing homes. Data were analyzed using Yin's 5-phase cycle. The findings revealed 3 major themes: develop knowledgeable staff, enhance communication with staff and residents, and promote innovation for continuous quality improvement. The implications for positive social change could include increased quality of patients' health care, creation of employment opportunities to promote prosperity in communities, and financial sustainability in the United States nursing home industry.