Ageing International

, Volume 41, Issue 1, pp 40–61 | Cite as

Mapping Nursing Home Inspections & Audits in Six Countries

  • Jacqueline A. Choiniere
  • Malcolm Doupe
  • Monika Goldmann
  • Charlene Harrington
  • Frode F. Jacobsen
  • Liz Lloyd
  • Magali Rootham
  • Marta Szebehely


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.


Long-term residential care Quality indicators Marketization Regulation 



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.

Compliance with Ethical Standards

Conflict of Interest

The authors have no conflict of interest.

Informed Consent

As there is no person or personal data appearing in the paper, there is no one from whom a permission should be obtained in order to publish personal data.

Ethical Treatment of Experimental Subjects (Animal and Human)

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Jacqueline A. Choiniere
    • 1
  • Malcolm Doupe
    • 2
  • Monika Goldmann
    • 3
  • Charlene Harrington
    • 4
  • Frode F. Jacobsen
    • 5
    • 6
  • Liz Lloyd
    • 7
  • Magali Rootham
    • 8
  • Marta Szebehely
    • 9
  1. 1.School of Nursing, Faculty of HealthYork UniversityTorontoCanada
  2. 2.Manitoba Centre for Health PolicyUniversity of ManitobaWinnipegCanada
  3. 3.Social Research CentreTU Dortmund UniversityDortmundGermany
  4. 4.Department of Social & Behavioral SciencesUniversity of CaliforniaSan FranciscoUSA
  5. 5.Center for Care Research - Western NorwayBergen University CollegeBergenNorway
  6. 6.Betanien University CollegeBergenNorway
  7. 7.University of BristolBristolUK
  8. 8.York UniversityTorontoCanada
  9. 9.Department of Social WorkStockholm UniversityStockholmSweden

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