Home and Community Care Digest

Home and Community Care Digest March 2003 : 0-0

Regulation does not ensure quality of care or better patient outcomes in LTC facilities


Three-year longitudinal study compares outcomes of residents in regulated and unregulated long-term care facilities in Quebec. Residents' survival time was mainly influenced by quality of care, not regulatory status of facilities. Findings suggest that regulation itself does not ensure good resident outcomes.
Background: Discrepancies exist between regulated and unregulated long-term care facilities in their ability to respond to residents' needs. Relationships between regulatory status, quality of care, and patient outcome are unclear.

Method: This 3-year longitudinal study compared: (a) resident outcomes, and (b) effect of quality care on length of stay in regulated and unregulated facilities in Quebec. Regulated homes were defined as those subjected to periodic government inspection, and unregulated homes as not subjected to inspection. Two hundred and ninety-nine residents from 88 facilities were followed. At baseline, nurses and social workers collected: demographics, functional status, cognitive impairment, and quality of care (QUALCARE Scale1). At 3-year follow-up, managers of participating facilities were contacted to obtain the following data: residents' status (i.e., alive versus dead, living in the same facility versus a transfer to a different facility), comorbidity, and hospitalizations.

Findings: Participants were predominantly female, over 80 years of age, widowed, and 46.8% had dementia. Those in regulated homes (n=124) scored significantly lower in cognitive and functional status at baseline than those in unregulated homes (n=175). At 3 years the study found that: (a) residents from unregulated facilities were more frequently hospitalized and for longer periods of time, and (b) approximately 60% of those from regulated facilities and 13% from unregulated facilities had died. Poor quality of care was found to increase residents' risk of death and transfer to another facility. Residents in unregulated facilities were found to have increased risk of transfer, but not death compared to those in regulated facilities.

Conclusions: Regulation itself does not ensure high quality of care or better patient outcomes. Regulatory status may have an indirect influence on quality of care through its effect on facility characteristics, such as, staff qualification and number of external collaborators. Residents' baseline characteristics, such as cognitive functioning may impact survival time in long-term care facilities.

Reference: Bravo G, Dubois M, de Wals P, Hébert R, Messier L. Relationship between regulatory status, quality of care, and three-year mortality in Canadian residential care facilities: A longitudinal study. Health Services Research 2002; 35(5):1181-1196.


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