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Mapping Nursing Home Inspections & Audits in Six Countries

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Abstract

International quality concerns regarding long-term residential care, home to many of the most vulnerable among us, prompted our examination of the audit and inspection processes in six different countries. Drawing on Donabedian’s (Evaluation & Health Professions, 6(3), 363–375, 1983) categorization of quality criteria into structural, process and outcome indicators, this paper compares how quality is understood and regulated in six countries occupying different categories according to Esping Andersen’s (1990) typology: Canada, England, and the United States (liberal welfare regimes); Germany (conservative welfare regime); Norway, and Sweden (social democratic welfare regimes). In general, our review finds that countries with higher rates of privatization (mostly the liberal welfare regimes) have more standardized, complex and deterrence-based regulatory approaches. We identify that even countries with the lowest rates of for profit ownership and more compliance-based regulatory approaches (Norway and Sweden) are witnessing an increased involvement of for-profit agencies in managing care in this sector. Our analysis suggests there is widespread concern about the incursion of market forces and logic into this sector, and about the persistent failure to regulate structural quality indicators, which in turn have important implications for process and outcome quality indicators.

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Notes

  1. These stakeholders include: Central Federal Association of LTCI, Federal Association of Supra-local Social Welfare Associations, Federation of Municipal Associations and Associations of Providers of Care Institutions at the federal level, Medical Service of the Central Federal Association of Health Insurances, Association of Private Health Insurances, Federal Associations of Nursing and Elderly Care Professions, and relevant organizations representing the interests and self-help of dependent and disabled people.

  2. This use of the expert standards of the German Network for Quality Development in Care (Deutsches Netzwerk für Qualitätsentwicklung in der Pflege – DNPQ) concerns technical nursing care and prevention measures. Expert standards include wound care, prevention of pressure sores, pain management, prevention of falls, discharge management and malnutrition.

  3. E.g., the safety and security core standard mandates all call systems to be in proper working order, all open stairwells are safeguarded, windows cannot be exits, and all outside and stairwell doors are alarmed, with approved locking devices under the Manitoba Fire Code (Manitoba Government 2012b).

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Acknowledgments

The authors wish to acknowledge funding support from the Canadian Social Sciences and Humanities Research Council (SSHRC), Collaborative Research Initiative (MCRI) for the research Initiative: Reimagining long-term residential care: An international study of promising practices, Pat Armstrong, York University, Toronto, PI [file#412-2010-1004]. The authors also wish to acknowledge research support from Samantha Posluns, MA, York University, Toronto Canada.

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Authors and Affiliations

  1. School of Nursing, Faculty of Health, York University, Toronto, Ontario, Canada

    Jacqueline A. Choiniere

  2. Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada

    Malcolm Doupe

  3. Social Research Centre, TU Dortmund University, Evinger Platz 17, 44339, Dortmund, Germany

    Monika Goldmann

  4. Department of Social & Behavioral Sciences, University of California, 3333 California Street Suite 455, San Francisco, CA, 94118, USA

    Charlene Harrington

  5. Center for Care Research - Western Norway, Bergen University College, Bergen, Norway

    Frode F. Jacobsen

  6. Betanien University College, Bergen, Norway

    Frode F. Jacobsen

  7. University of Bristol, Bristol, UK

    Liz Lloyd

  8. York University, Toronto, ON, Canada

    Magali Rootham

  9. Department of Social Work, Stockholm University, Stockholm, Sweden

    Marta Szebehely

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Choiniere, J.A., Doupe, M., Goldmann, M. et al. Mapping Nursing Home Inspections & Audits in Six Countries. Ageing Int 41, 40–61 (2016). https://doi.org/10.1007/s12126-015-9230-6

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