Does regulating private long-term care facilities lead to better care? A study from Quebec, Canada.

OBJECTIVE: In the province of Quebec, Canada, long-term residential care is provided by two types of facilities: publicly funded accredited facilities and privately owned facilities in which care is privately financed and delivered. Following evidence that private facilities were delivering inadequate care, the provincial government decided to regulate this industry. We assessed the impact of regulation on care quality by comparing quality assessments made before and after regulation. In both periods, public facilities served as a comparison group. DESIGN: A cross-sectional study conducted in 2010-12 that incorporates data collected in 1995-2000. SETTINGS: Random samples of private and public facilities from two regions of Quebec. PARTICIPANTS: Random samples of disabled residents aged 65 years and over. In total, 451 residents from 145 care settings assessed in 1995-2000 were compared with 329 residents from 102 care settings assessed in 2010-12. INTERVENTION: Regulation introduced by the province in 2005, effective February 2007. MAIN OUTCOME MEASURE: Quality of care measured with the QUALCARE Scale. RESULTS: After regulation, fewer small-size facilities were in operation in the private market. Between the two study periods, the proportion of residents with severe disabilities decreased in private facilities whereas it remained >80% in their public counterparts. Meanwhile, quality of care improved significantly in private facilities, while worsening in their public counterparts, even after controlling for confounding. CONCLUSIONS: The private industry now provides better care to its residents. Improvement in care quality likely results in part from the closure of small homes and change in resident case-mix.

[Development and validation of a Quebec classification of private residences with services welcoming of older persons]. / Développement et validation d'une classification québécoise des résidences privées avec services accueillant des personnes âgées.

Private Residential Care Facilities (RCFs) fill the gap between independent community living and institutional settings for seniors. There are marked differences between RCFs which make them difficult to compare. To address this issue, the objective of this study was to develop and validate a classification of RCFs based on their physical and organizational environments. RCF owners across Quebec were invited to complete a questionnaire that described the setting's physical and organizational environment. Different combinations of cluster analysis methods and statistical parameters were used to identify plausible classifications. The final choice was made by an expert committee. Overall, 552 owners returned the questionnaire. Three plausible classifications were submitted to the committee. The selected classification included five clusters that differed with regard to admission criteria, services offered and recreational activities. This classification could help health professionals select the RCF that best responds to older adults' needs.

Identifying psychosocial variables for home care services and how to measure them.

A Delphi-type expert consultation founded on the RAND/UCLA Appropriateness method was used to select variables related to older adults and environment characteristics perceived essential in assessing psychosocial needs and that could influence the social work workload in home care services. After two rounds of consultation, the 60 experts reached a consensus on 97 variables out of the 160 considered. A focus group made up of 10 experts identified tools that would allow us to measure the variables in a clinical context. Eighty-three percent of the variables selected could be measured with five instruments identified by the focus group experts.

Identifying characteristics of residential care facilities relevant to the placement process of seniors.

OBJECTIVE: To identify which characteristics of the physical and organizational environments of residential care facilities (RCFs) need to be known to support the placement process of seniors with cognitive and physical disabilities. DESIGN: We used a 2-round postal Delphi survey based on the RAND/UCLA Appropriateness Method with 2 groups of experts. PARTICIPANTS: Participants are representatives of concerned stakeholder groups from various sectors (public, private, and community) and geographical regions within the province of Quebec, Canada. RESULTS: Of the 58 persons who were interested in participating, 48 (82.8%) returned their questionnaires. The first group identified 171 items essential to consider when a cognitively impaired senior needs to move into an RCF. Of these, 88 were related to the physical environment of the RCF and 83 to its organizational environment. The second group identified 146 items to be relevant to consider when a senior with physical impairments needs to choose an RCF; 75 for the physical and 71 for the organizational environment. 85% of the items selected by both groups (cognitive versus physical group) were identical. CONCLUSION: This study provided a list of important items that described residential care facilities in regard to their physical and organizational environments to support the placement process of seniors. It also provides the possibility to develop a self-administered tool that will supply valuable information to seniors and their relatives, to health care professionals, and to administrators and decisions-makers.