Challenges of Regulatory Compliance in the Long-Term Care Sector in Ontario

In Canada and around the world, it is hard to ignore the dreadful toll of the COVID-19 pandemic in Long-Term Care (LTC) homes (also known as nursing homes). The first and second waves of the COVID-19 pandemic exposed numerous gaps in the Canadian LTC system (Liu et el., 2020; Jackman, 2020). There is a window of opportunity (Béland & Marier, 2020) for scholars to contribute to public debates about how to improve institutional LTC. The purpose of this paper is to report on the preliminary research findings from the first stage of a project intended to explore why and in what circumstances LTC homes comply with regulatory requirements, and when they do not, in order to contribute to the public and scholarly debates about LTC in a post-pandemic world. This proposed research is explicitly aimed at policy-oriented analysis and critique of regulatory design, implementation and enforcement in the LTC system in the province of Ontario, which is the largest province in Canada. The lessons learned in this project will be of interest to scholars in other OECD countries. Part one of the paper will outline the four main conceptual themes or sets of independent variables of interest in explaining compliance: economic, social and normative motives, organizational capacities and characteristics, regulation and enforcement, and social and economic environments (or institutions) (Parker & Neilson, 2011). Variation in motives is only one among many factors explaining why some regulated entities are better at complying than others (Neilson & Parker 2012). Accordingly, in addition to motives, this project will investigate the influence of regulatory institutions – regulators and regulatory enforcement – on compliance (May and Winter, 2011; Neilson & Parker, 2012). Part two paper of the paper will begin by offering a primer of LTC in Ontario. Then the paper will explain the research methodology used. The first phase of the empirical research is semi-structured key informant interviews (Gilchrist & Williams, 1999) with associations, unions and professionals who provide advice on compliance, such as lawyers. The potential participants will be chosen based on purposive sampling (Gilchrist & Williams, 1999, p.75). Interviewees will be asked to share their views about topics such as priorities of various motives (economic, social and normative) of senior management of homes observed by the interviewees and other factors that contribute to non-compliance. The analysis of text in the interview transcripts will be based on thematic analysis (Ayres, 2008; Ryan & Bernard, 2003). The final part of the paper will analyze the key themes emerged from the key informant interviews. It is expected that the research will generate preliminary findings about identifying and conceptualizing motives, constraints and regulatory strategies relevant to regulatory compliance in LTC. The gaps in the literature will also be identified. Based on the results of the interviews, the next phase of the empirical research is to undertake an anonymous web-based survey of a larger number of professionals (lawyers and non-lawyers) who have experience with enforcement and compliance, for example, advising clients on risk management.