Assessing the Impact of Enforcement on Long-Term Care (LTC) homes

Compliance is defined as the interaction between rules and behavior (Van Rooij and Sokol 2021). While the state has traditionally been assumed as key actor in the regulation and enforcement of business behavior, in the past few decades the responsibility and authority for monitoring and enforcement of compliance have increasingly been delegated to a wide range of private actors (van Wingerde and Bisschop 2022). It may be more apt to describe a regulatory system as consisting of layered webs of regulatory influence: activities of public regulatory agencies constitute a few strands and other strands of this web may be subject to government influence, but others may be quite independent from government influence (Grabosky, 1995). To be certain, a "weak" regulator can very well be the result of self-imposed constraints (Grabosky, 1995) and political ideologies such as New Public Management. Nonetheless, a regulatory vacuum may be created due to state inaction. This paper is situated in the regulation of social care literature (for example see Dolev and Benish 2023). Since social care is intended for people in vulnerable situations, regulatory bodies are expected first and foremost to protect service users and promote their well-being (Furness, 2009). One of the main regulatory tasks is monitoring standard compliance and enforcement (Dolev and Benish 2023). Lack of monitoring and enforcement may result in a regulatory vacuum. An example of such regulatory vacuum is long-term care (LTC) homes (also known as nursing homes or aged care). In many OECD countries such as Canada, LTC is highly regulated. Poor (even deadly) care in LTC homes around the world prompted demands for reform (for example see Kohn 2021). This paper focuses on lack of, or under-enforcement, of regulation in LTC. This paper reports on the analysis of inspection reports of LTC homes in Ontario, the largest province in Canada. The analysis is part of a larger research project about enforcement and compliance in LTC in Ontario. This paper relies on quantitative analysis. A dataset of ~ 626 homes was created. The dataset includes: 1) background information about the homes (such as number of beds, geographic location, ownership status); 2) information extracted from inspection reports released in 2021, 2022 and 2023 (such as the sanctions issued by inspectors). All the data was retrieved from the Ontario Government website. Data entry was done by a team of research assistants. The data will be used to examine factors that are positively and significantly correlated with non-compliance (as evidenced by the number of sanctions). Also, the data will be used to hypothesize how regulated entities react to the weakening, or at the very least, the symbolic withdrawal of state regulatory activities. This project has implications for designing inspection and enforcement strategies in social services.