title: Does regulating private long-term care facilities lead to better care? A study from Quebec, Canada.
abstract: 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.
  
  
  METHODS
  A cross-sectional study conducted in 2010-12 that incorporates data collected in 1995-2000.
  
  
  METHODS
  Random samples of private and public facilities from two regions of Quebec.
  
  
  METHODS
  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.
  
  
  METHODS
  Regulation introduced by the province in 2005, effective February 2007.
  
  
  METHODS
  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.
authors.affiliation: Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, QC, Canada.
authors.forename: Gina
authors.initials: G
authors.lastname: Bravo
authors.affiliation: Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, QC, Canada.
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Dubois
authors.affiliation: École Nationale d'Administration Publique (ENAP), Québec, QC, Canada Centre de Recherche du CHU de Québec, Québec, QC, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Demers
authors.affiliation: Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, QC, Canada School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Dubuc
authors.affiliation: Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, QC, Canada Department of Accounting Sciences, Faculty of Business Administration, Université de Sherbrooke, Sherbrooke, QC, Canada.
authors.forename: Danièle
authors.initials: D
authors.lastname: Blanchette
authors.affiliation: Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, QC, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Painter
authors.affiliation: Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, QC, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lestage
authors.affiliation: Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, QC, Canada.
authors.forename: Cinthia
authors.initials: C
authors.lastname: Corbin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000331:legislation & jurisprudence* / Q000592:standards*; D008297:Male; D017149:Private Sector; D058996:Quality Improvement; D011792:Quebec
keywords: Canada; elderly; long-term care facility; quality of care; regulation
references.citation: Health Policy. 2006 Dec;79(2-3):175-94
references.pmid: 16430989
references.citation: CMAJ. 1999 May 18;160(10):1441-5
references.pmid: 10352633
references.citation: J Am Med Dir Assoc. 2008 Feb;9(2):95-101
references.pmid: 18261701
references.citation: Open Med. 2011;5(4):e183-92
references.pmid: 22567074
references.citation: Int J Nurs Stud. 1990;27(1):61-75
references.pmid: 2312236
references.citation: CMAJ. 1998 Jul 28;159(2):143-8
references.pmid: 9700325
references.citation: Int J Nurs Stud. 1990;27(1):77-91
references.pmid: 2312237
references.citation: Gerontologist. 2011 Oct;51(5):610-6
references.pmid: 21602292
references.citation: J Public Health Manag Pract. 2007 Jul-Aug;13(4):349-56
references.pmid: 17563622
references.citation: Healthc Pap. 2011;10(4):8-22
references.pmid: 21593611
references.citation: Gerontologist. 2010 Aug;50(4):426-42
references.pmid: 20631035
references.citation: Health Serv Manage Res. 2004 May;17(2):79-99
references.pmid: 15198856
references.citation: J Nurs Scholarsh. 2012 Mar;44(1):88-98
references.pmid: 22340814
references.citation: J Aging Soc Policy. 2009 Oct-Dec;21(4):318-37
references.pmid: 20092125
references.citation: J Clin Psychiatry. 1987 Aug;48(8):314-8
references.pmid: 3611032
references.citation: Health Serv Res. 2009 Jun;44(3):1088-109
references.pmid: 19674434
references.citation: J Am Med Dir Assoc. 2006 Oct;7(8):532-8; discussion 538-40
references.pmid: 17027632
references.citation: Health Care Manag (Frederick). 2012 Apr-Jun;31(2):121-31
references.pmid: 22534968
references.citation: J Gerontol B Psychol Sci Soc Sci. 1999 May;54(3):P180-8
references.pmid: 10363040