The cumulative growth in the aging population in the U.S. calls for a high demand for long-term care (LTC) facilities. Furthermore, the LTC (e.g., nursing homes and assisted living facilities, etc.) consumers have become widely diverse (i.e., not just limited to older groups but now included children and adults with disabilities); demand for wide range of needs and support services. In coping with this changing environment, the LTCs, especially operating in rural settings, are faced with multifaceted challenges related to direct care staffing and turnover. In response to this outlook, the present study explores a research question to understand, how do rural skilled nursing facilities (SNF) Administrators perceive their challenges of CNA retention? In 2018, Dr. Donald Ebel from Minnesota State University, Mankato Aging Studies Program conducted 11 qualitative in-depth interviews with rural SNF administrators to identify factors of how the role of this position in rural areas was affected. The interviews conducted by Dr. Ebel included a semi-structured questionnaire with objectives to identify factors related to CNA turnover at rural SNF facilities, as well as, to identify the challenges and barriers to CNA retention. A qualitative content analysis of the interview transcripts clustered around the factors, such as minimum wage, determinates from socioeconomics and organizational structures and the changes of LTC services and competition as the main barriers. The study findings, especially, the challenges and barriers among LTC and SNFs would help in planning for effective strategies for evolving CNA needs, e.g., what resources are available and how to retain them for the rural SNFs.


Saiful Islam

Committee Member

Donald Ebel

Committee Member

Aaron Hoy

Date of Degree




Document Type



Master of Science (MS)


Social and Behavioral Sciences



Rights Statement

In Copyright