[State of practice: regulation of private congregate living facilities for the elderly]

Provençal BP
Record ID 32018000982
Original Title: État des pratiques: régulation des lieux d'habitation collectifs privés pour ainés
Authors' objectives: Private seniors’ residences, as they are called in Quebec, are congregate living facilities that offer a variety of services to the occupants, such as meals, domestic help and personal assistance. These residences meet a constantly increasing demand. Many people aged 75 and over live in this type of residence. The attraction rate for private seniors’ residences is greater in Quebec than anywhere else in North America. To ensure the safety and quality of accommodations, services and care, private seniors’ residences are regulated by the Government of Quebec through legislation, i.e., the Regulation respecting the conditions for obtaining a certificate of compliance and the operating standards for a private seniors’ residence. Few studies, however, have explored the methods used to regulate private seniors’ residences and the impact of regulation on the development of this service sector. That is why the Direction du soutien à domicile (DSAD) at the Ministère de la Santé et des Services sociaux (MSSS) mandated INESSS to document how these issues are addressed in other jurisdictions.
Authors' results and conclusions: RESULTS: There exist various fiscal measures to facilitate access to PCLCFEs. Some consist of financial support to pay the rent, but most of them focus on home-based services offered in PCLCFEs. The various arrangements identified in the literature feature a mix of types of support funding for loss of autonomy. Some countries provide universal coverage in a single funding program; others offer a safety net tailored to the individual’s financial resources; finally, certain countries apply a mixed system. The senior housing sector is presently facing at least three (3) major trends. The first trend is that home-based services are gradually becoming exposed to the rise of a mixed economy, which rests chiefly on public funding of services offered in the private sector. The second trend deals with the adjustment of the offer with the demand for PCLCFEs, some of them originally designed to deliver services to occupants who are relatively independent; in the context of the ageing of this clientele, certain adjustments to the services offered by the PCLCFEs are needed. The third trend stems from the growing number of senior citizens who will require home-based assistance, according to demographic projections. Responding to those needs will require hiring qualified staff in sufficient number. However, the fact that working conditions are considered unsatisfactory by some people suggests that employee recruitment and retention are likely to pose significant challenges. CONCLUSION: This review describes PCLCFE regulation in Canada outside Quebec and in other countries. This subject has so far been little studied and is still poorly documented. While this portrait can serve as a starting point for reflection on Quebec’s approach to regulation of private seniors’ residence, its purpose was not to determine what might be the best way to ensure that the services provided in those facilities are safe and of proper quality while respecting the many constraints of resources faced by the stakeholders concerned. This being said, a number of issues raised may prove useful in guiding our reflection. Future studies may benefit from the content of this review and contribute to improve knowledge on PCLCFE regulation. Building on these studies and considering ongoing demographic and epidemiological transitions, Quebec’s response to sociosanitary needs can only be expected to improve.
Authors' methods: The regulation of private congregate living and care facilities for the elderly (PCLCFE) – a generic term equivalent to private seniors’ residences in Quebec on a world scale –, is three-fold: monitoring, delivery of services and funding. In order to determine how those facilities are actually regulated, scientific and grey literature on this particular topic was compiled and an analytical narrative synthesis based on the selected documents was conducted. This literature review allowed to establish a summary profile of methods used to regulate PCLCFEs in various Canadian provinces and countries. Monitoring is seen from the perspective of legislative frameworks and compliance mechanisms in place. Legislative frameworks applying to life and services in PCLCFEs exist in other Canadian provinces and other jurisdictions; it is organized around standards and norms related to various spheres of residence life, such as the physical environment and maintenance, food services and direct care services. The standards and norms vary from one jurisdiction to another and apply to living environments that do not always accurately reflect the reality observed in Quebec private seniors’ residences. The regulation is often tailored to the type of clientele and the characteristics of PCLCFEs, as indicated in statements found in legislative literature. While there are a number of differences between the laws and regulations applicable to PCLCFEs, there are however many similarities in their content. This being said, the use of clear and specific quality or safety indicators is not widespread. The delivery of services in PCLCFEs calls for the participation of a diversified workforce. Standards, training programs and qualifications vary across jurisdictions. While legislation applying to PCLCFEs specifies certain conditions and requirements, their owners sometimes have some flexibility in the monitoring of certain directives. Example of this is a directive in some U.S. states to maintain a sufficient number of staff. Other jurisdictions, however, apply very clear and specific criteria. In addition to these standards and norms, several mechanisms are prescribed by legislation to ensure that they are respected. Many jurisdictions have such mechanisms, including assessments supervised by specific public organizations. Inspections may be announced or unannounced, and consequences for not complying can range from a simple notice to the closure of the facility. Assessments are sometimes made public and accessible online so that future occupants and families can compare PCLCFEs.
Project Status: Completed
Year Published: 2018
Requestor: Minister of Health
English language abstract: An English language summary is available
Publication Type: Other
Country: Canada
Province: Quebec
MeSH Terms
  • Nursing Homes
  • Assisted Living Facilities
  • Long-Term Care
  • Frail Elderly
  • Housing for the Elderly
  • Aged
  • Aged, 80 and over
  • Homes for the Aged
  • Government Regulation
  • Quality Assurance, Health Care
  • Health Facilities, Proprietary
  • Private Sector
  • Quality of Health Care
  • Private congregate living facilities
  • Elderly
Organisation Name: Institut national d'excellence en sante et en services sociaux
Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.