A comparative analysis of regulatory models in the assisted living sector in Canada and impacts on integrated care

Introduction: In Canada, the increasing prevalence of assisted living allows older adults continued independence while offering a shared community and options for help with services like meal preparation, housekeeping, personal and medical care. However, concerns about care quality arises in provinces with a largely for-profit, private pay assisted living model. Regulation of the assisted living sector across Canada is fragmented with regulatory models varying by province. This has created a context of mixed enforcement of assisted living legislation and standards of care. This project compares the different regulatory approaches undertaken by two large Canadian provinces, British Columbia and Ontario. Our aim is to understand why different regulatory models were adopted and how each model influences care planning and care integration for residents receiving care both within their assisted living facility and from the broader health care system. Approach/Methods: This project began with a content analysis of assisted living legislation, regulation, and associated policies in Ontario and British Columbia (n=8) to determine similarities and differences among the two regulatory models. We then used semi-structured interviews (n=12) of policy makers who were involved in, or had knowledge of, the development of the two regulatory methods guided by the ideas, interests, and institutions framework. Our aim was to understand how and why each model was selected and the implications for care integration with a focus on care planning and interprofessional collaboration. Interview data was analyzed using reflexive thematic analysis and our interpretation of the contributions of the regulatory approaches in facilitating the integration of care was guided by the OECD Framework for Regulatory Policy Evaluation. As next steps, our research team will host a deliberative dialogue with key stakeholders to draft policy options to inform future regulatory work in the assisted living sector across Canada. Results: Key themes in our findings so far suggest that despite some overlap in service provision and target population, the two regulatory models studied conceptualised “care” differently leading to different groups of services being subject to regulation. Regulations in British Columbia emphasized resident independence and framed assisted living as a form of supportive housing with little “care” provided. In contrast, Ontario’s regulations focused on the more medicalized care provided in assisted living homes with a particular focus on the care provided by regulated healthcare professionals and an absence of discussion on how care by personal support workers should be monitored. International Learnings: Poor clarity and a lack of consistency in regulating assisted living makes it difficult to understand how care provided in this growing sector fits within the broader health care continuum. The findings from this study provide a better understanding of what types of services and care providers can be regulated most effectively to achieve the aim of ensuring care quality and integration, the effectiveness of regulation as an enforcement mechanisms to ensure compliance in a highly privatized sector, and the impact of regulation on care planning and the integration of care across care providers both inside and outside the assisted living sector.

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