Regulation of long-term care for older persons: a scoping review of empirical research

Abstract

Objective: Not only care professionals are responsible for the quality of care but other stakeholders including regulators also play a role. Over the last decades, countries have increasingly invested in regulation of Long-Term Care (LTC) for older persons, raising the question of how regulation should be put into practice to guarantee or improve the quality of care. This scoping review aims to summarize the evidence on regulatory practices in LTC for older persons. It identifies empirical studies, documents the aims and findings, and describes research gaps to foster this field. Design: A literature search (in PubMed, Embase, Cinahl, APA PsycInfo and Scopus) was performed from inception up to December 12th, 2022. Thirty-one studies were included. Results: All included studies were from high-income countries, in particular Australia, the US and Northwestern Europe, and almost all focused on care provided in LTC facilities. The studies focused on different aspects of regulatory practice, including care users’ experiences in collecting intelligence, impact of standards, regulatory systems and strategies, inspection activities and policies, perception and style of inspectors, perception and attitudes of inspectees and validity and reliability of inspection outcomes. Conclusion: With increasingly fragmented and networked care providers, and an increasing call for person-centred care, more flexible forms of regulatory practice in LTC are needed, organized closer to daily practice, bottom-up. We hope that this scoping review will raise awareness of the importance of regulatory practice and foster research in this field, to improve the quality of LTC for older persons, and optimize their functional ability and well-being.

Perspectives on regulating long-term care

“…In this context, the paper of Pot and colleagues offers a most valuable contribution by depicting the state of play of research up to now. It describes what topics were researched over those thirty years: care users’ experiences in collecting intelligence, impact of standards, regulatory systems and strategies, differences and changes in inspection interventions, perception and style of inspectors, perception and attitude of inspectees, and reliability and validity of inspection outcomes (Pot et al ., 2023).…”

“…Professional LTC makes a specific contribution to a person’s quality of life based on his/her choices and capabilities, his/her social network, and their social and physical context. The current focus on person-centered care reflects this approach (Beard et al ., 2016; EC, 2021; EC, 2022; Pot et al ., 2023; Pot, 2022).…”

“…These different objectives may require different inspection strategies (Leistikow, 2018). They should go hand-in-hand with a deeper understanding of mechanisms of change and implementation strategies in order to have an impact on daily practice (Hovlid et al ., 2022; Pot et al ., 2023). When findings of inspection procedures cannot be transferred to effective interventions, regulation will not have any added public value.…”

“…There is a good point to make, as Pot et al . (2023) do, that LTC requires less standardized methods than for instance the health care sector. This implies, for instance, that in addition to “command and control regulation”, more reflexive forms of regulation are needed (Pot et al ., 2023; Pot, 2022).…”

“…(2023) do, that LTC requires less standardized methods than for instance the health care sector. This implies, for instance, that in addition to “command and control regulation”, more reflexive forms of regulation are needed (Pot et al ., 2023; Pot, 2022). Both types of regulation “set standards and criteria, collect information to assess whether the services comply with the criteria, and take action to meet criteria and make improvements” (Rutz, 2017, p. 14).…”