Foreword

A key but neglected issue in long-term care is how different countries ensure that nursing homes, home care agencies and residential care facilities provide good-quality care. Although countries employ a number of strategies to accomplish this goal, the most common approach is regulation – to establish mandatory, government or government agent-imposed quality standards (Wiener et al., 2007a, 2007b). In most cases, these government regulations or other standards set the minimum quality that providers must meet to operate or to receive government funding. The role of government regulation in long-term care varies widely across countries, within countries and across services. In most countries, long-term care is heavily financed by the public sector (European Commission, 2012; OECD, 2005). Thus, governments have a fiduciary responsibility to ensure that the public’s money is well spent. This book fills an important gap by analysing how a large number of countries around the world regulate the quality of long-term care services and the extent to which they make the results of their inspections and other information on quality available to the public.

Although some countries, such as the United States, have well-established regulatory systems, others, such as China, do not. But having a well-established regulatory system does not guarantee that all providers establish high quality. For example, in the United States, 23 per cent of nursing homes in 2010 were cited for causing actual harm or placing residents in jeopardy (Harrington et al., 2011). Moreover, during that same year, the US Administration on Aging received 157,962 complaints from nursing home residents or their families about poor quality of care, problematic quality of life and violations of resident rights (US Administration on Aging, 2011). Additionally, almost nothing is known about the quality of residential care facilities because these providers are regulated at the state level using highly variable standards and the provision of personal care by home care agencies and individual providers is hardly regulated.