Managing Dementia Care: Challenges and Coping Strategies of Administrators In Chinese Faith-Based Nursing Homes

Background and Purpose: China has the largest population of older adults in the world (Lei et al., 2024) and is confronting the challenge of a rapidly growing population wrestling with dementia, which is projected to reach 40 million by 2050 (Liu et al., 2025). Faith-based nursing homes play a small, but vital, role in caring for these older adults, especially those with dementia who are often hard to place. However, the challenges administrators of these nursing homes encounter, along with the coping strategies they employ to manage them, have yet to be explored. Previous studies on nursing home administrators have primarily focused on Western countries (Corazzini et al., 2015; Pradhan et al., 2024; Ree, 2020; Rokstad et al., 2015). To address this gap, this study aims to identify the primary stressors faced by administrators of faith-based nursing homes in China and the strategies they use to cope with them.

Methods: A qualitative descriptive design was used in conjunction with a purposive sampling procedure, prioritizing heterogeneity to enhance the trustworthiness of the findings (Kirchherr & Charles, 2018). The resulting sample consisted of administrators (N=21) who managed faith-based nursing homes in 12 provinces—located in cities (n=13), towns (n=7), and villages (n=1)—with an average of 115 beds (SD=73.58). Most administrators were Chief Directors (n=13), women (n=21), Protestants (n=19), with a mean age of 48.95 (SD=10.09), and roughly four years in administration (M=3.85, SD=3.61).

A post-positivist epistemological perspective guided an interpretive content analysis of the data (Drisko & Maschi, 2016). Semi-structured interviews were administered in Mandarin and then translated into English. A constant comparative methodology was used to examine the transcripts for similarities, which were then coded into themes (Padgett, 2017). To help ensure the trustworthiness of the resulting themes, member-checking was employed in which the themes were translated back into Mandarin and sent to study participants to verify their accuracy.

Results: The findings revealed the primary stressors encountered by administrators, namely: 1) managing residents with dementia, 2) ensuring adequate staffing, 3) financial pressures, 4) dealing with governmental regulations, and 5) engaging with difficult family members. In addressing these challenges, the commonly employed coping strategies included 1) integrating spiritual practices (e.g., prayer), 2) addressing the identified stressors (e.g., continuous staff recruitment), and 3) using personalized approaches (e.g., walking in nature).

Conclusion and Implications: Understanding the challenges administrators of faith-based nursing homes face and the strategies they use to cope is imperative for advancing gerontological social work policy and practice in China and perhaps in many other nations. This is the first study to identify the substantial, interconnected challenges and coping mechanisms used by administrators, including the importance of spirituality. The findings emphasize the need for policies and initiatives that not only prioritize the care of older adults in nursing homes but also support the overall well-being of administrators, which includes addressing their spiritual needs (Pradhan et al., 2024). Recognizing administrators’ coping strategies is crucial for developing appropriate support interventions that address their needs, mitigate burnout, and position them to lead effectively.