What drives compliance in institutional long-term care over time? The case of Ontario, Canada

In Canada and around the world, the COVID-19 pandemic exposed numerous gaps in the regulation of institutional long-term care (LTC) (also known as nursing homes or aged care homes) (Liu et el., 2020; Jackman, 2020). Accordingly, there has been a flurry of reform proposals originating from numerous sources to improve LTC around the globe. The purpose of this paper is to report on the preliminary findings of an on-going research about more effective inspection and enforcement in the LTC sector in Ontario, which is the largest province in Canada. This project is situated in the regulation and governance literature. This research is explicitly aimed at analysis and critique of regulatory design, implementation and enforcement in the LTC system in Ontario. The first part of the paper introduces three theories: responsive regulation (Ayres & Braithwaite 1992; Braithwaite, 2002; Parker 2021), compliance (Parker & Nielsen, 2011; Parker & Nielsen, 2017; van Rooij & Sokol, 2021) and hybrid accountability (Benish, 2020; Benish & Mattei, 2020). It is followed by the methodology section. The second part provides an introduction to the LTC sector in Ontario. The main part summarizes the findings from a small number of key informant interviews and an anonymous on-line survey with participants in the sector. My hypothesis is that the current enforcement strategies do not appear to evoke responsiveness in at least some of the LTC homes because the regulator’s approach is not dynamic: the regulator does not change its mix of “carrots” and “sticks” in order to respond to the motivations and behaviours of homes. If deterrence is indeed achieved dynamically through escalation (Dukes et al., 2014), then Ontario’s approach is best described as passive. The research findings will be of interest to other OECD countries.