The impact of regulation on the quality of care in nursing homes in Ireland: a time-series analysis of change in compliance

Abstract

Background Quality in health and social care is of paramount importance. Regulation is often used for ensuring or promoting quality in care services. Services are typically regulated by independent public authorities, which monitor services for compliance with regulations. There is limited research, however, on services’ compliance with regulations to provide a high quality of care. This study aims to examine nursing home compliance with regulations relating to quality. Methods Secondary legislation used for regulating nursing homes in Ireland was mapped to the Donabedian’s quality framework with each regulation categorised as either “structure”, “process” or “outcome”. The regulations categorised as “outcome” were determined to be quality-related regulations; such regulations were extracted and became this study’s area of focus. Published inspection reports from the regulator in Ireland for a three year period (2019 to 2021) (n=1,153) were assessed. The frequency with which the “outcome regulations” were inspected in nursing homes, and the proportion of compliance achieved, was calculated. Change in compliance levels across the three years was evaluated using Chi2 tests. Results Ten regulations were categorised as “outcome regulations” and addressed the following areas: positive behaviour; protection; residents' rights; communication; visits; personal possessions; food and nutrition; information for residents; medicines and pharmaceutical services; and complaints procedures. Compliance with two regulations (‘Regulation 9: Residents’ rights’ and ‘Regulation 11: Visits’) significantly improved during the three years (p<0.05). Compliance with ‘Regulation 12: Personal Possessions’ significantly decreased over the three years, however, so did the proportion found not compliant. While there was no significant change in the other regulations examined, compliance trended towards improvement, except for one regulation, ‘Regulation 20: Information for residents’, which trended downwards. Conclusion This analysis of national-level data found improvements in compliance across nearly all quality-related regulations demonstrating that regulation can be a positive influence on quality maintenance and improvement.