Chapter
Part II Long-term care quality systems based on ‘professionalism’
2 Performance measurement in long-term care in Austria
2.1 The emerging Austrian long-term care system in the context of a federal constitution
2.1.1 A note on terminology
2.2 The extent of formal long-term care services in Austria
2.2.1 Home care and intermediary care services
2.2.2 Residential care facilities
2.3 The regulatory framework for quality assurance and performance measurement of long-term care services in Austria
2.3.1 The regulatory structure for residential facilities and community-based services
2.3.2 Application and authorization
2.3.4 Quality assurance, monitoring and inspection
2.3.5 Quality assurance in acute healthcare
2.4 Quality management and quality development at the provider level – a voluntary bottom-up approach
2.4.1 European Quality Improvement and Innovative Learning (E-Qalin)
2.4.2 The National Quality Certificate (NQZ) for care homes
2.5 Challenges for transparency and performance management of long-term care in Austria
3 Monitoring the quality of long-term care in Germany
3.2 The regulatory background to quality management and assurance
3.2.1 Long-term care insurance: legislation, beneficiaries, purchasers and providers
3.2.2 Regulatory responsibilities and powers
3.2.3 Current regulation regarding quality
3.3 The process of quality evaluation
3.3.1 The central role of the Medical Review Boards
3.3.2 Guidelines on Quality Evaluation
3.3.3 Implementation of the general commitment to quality at the level of care providers
3.3.5 Public reporting: MDK reports on quality
3.3.6 Outcome measurement and performance
3.3.7 Providers’ positioning in the care market, audits and certification
4 Quality monitoring and long-term care in Switzerland
4.1 Long-term care and its regulatory context in Switzerland
4.1.1 Federal health insurance law
4.1.2 Quality regulation of long-term care at the federal level
4.2 Nursing home quality regulation
4.2.1 Licensing and operation rules
4.2.2 Definition of quality and quality standards in residential facilities
4.2.3 Quality control and audits in nursing homes
4.2.4 Summary of nursing home regulation
4.3 Home care quality regulation
4.4 Quality assurance efforts by other players in long-term care
4.4.1 Outcome quality indicators in RAI institutions
4.4.2 Other quality management systems
5 Japan’s long-term care regulations focused on structure – rationale and future prospects
5.2 Background to long-term care in Japan
5.3 Regulatory principles in LTCI
5.4 Monitoring and reporting
5.5 Why are regulations focused on structure?
5.6 Problems inherent to focusing on structure
5.7 Prospects for the future
Part III Long-term care quality systems based on regulatory inspection frameworks
6 Regulating long-term care quality in Australia
6.2 Overview of Australia’s aged care system and its quality framework
6.2.1 Context – the broader health and welfare sector
6.2.2 The aged care sector
6.3 Arrangements for regulating the quality of residential care
6.3.1 Accreditation and compliance arrangements
6.3.2 Effectiveness of the quality framework
6.4 Arrangements for regulating the quality of community care
6.4.1 Community care packages
6.4.2 The Home and Community Care Programme
6.6 Current reform initiatives and policy challenges
6.6.1 Developing integrated quality regulation across community and residential care
6.6.2 Developing the performance framework and incentives for higher quality
6.6.3 Opportunities and risks associated with the movement towards consumer-directed care
6.6.4 Creating a single entry point and improving the quality and consistency of assessments
6.6.5 Better integration of quality arrangements with other parts of the regulatory framework
6.6.6 Integration with the wider health and community services system
7 Regulating the quality and safety of long-term care in England
7.2 Demand for long-term care and the structure of the market
7.3 Regulation of long-term care
7.4 Registration and certification of providers
7.5 Monitoring compliance with the regulations
7.5.2 Continuous assessment
7.5.4 Compliance among providers
7.6 Sanctions and enforcement mechanisms
7.7 Public reporting of provider quality and safety
7.9 Limitations to the scope of regulations
7.10 Future prospects and challenges
8 Quality monitoring of long-term care for older people in The Netherlands
8.2 Long-term care for older people
8.2.2 Current issues in long-term care
8.3 Legislation and regulations in the long-term care sector
8.4 Long-term care quality systems and certification, quality indicators and the role of the Healthcare Inspectorate
8.4.1 Quality of long-term care
8.4.2 Monitoring quality of care – the role of the Dutch Healthcare Inspectorate
8.4.2.1 Method 1: phased supervision
8.4.2.2 The Zichtbare Zorg (Visible Care) Programme
8.4.2.3 Method 2: Investigation of incidents
8.4.2.4 Method 3: Monitoring based on themes
8.4.2.5 Method 4: Enforcement measures
8.5 Transparency of the performance of long-term care organizations for clients and society – public reporting
8.5.1 Information provided by the Healthcare Inspectorate
8.5.2 Information published by long-term care providers
8.5.3 Information published on an independent national website
9 The regulatory structure of Spanish long-term care: the case of Catalonia’s service structures and quality assurance systems
9.2 The new Spanish framework for long-term care
9.2.2 A note on terminology
9.3 The quality approach in Catalonia
9.4 The customer’s perspective in Catalonia: a chronological overview
9.5 The nursing home and the acute care hospital network
Part IV Long-term care quality systems based on data measurement and public reporting
10 Monitoring the quality of long-term care in Finland
10.2 Delivery and financing of long-term care
10.2.1 Types of services delivered
10.3 Official regulatory mechanisms
10.4 Quality management and improvement
10.5 Summary and discussion
11 Regulation of long-term care in the United States
11.2 Demand for long-term care services in the United States
11.3 Historical development of long-term care regulation
11.4 Requirements for nursing home providers
11.4.1 Delineation of responsibility
11.4.2 Federal CMS requirements of participation
11.4.2.1 Regulatory requirements
11.4.2.2 Minimum Data Set
11.4.3 State implementation of CMS regulations
11.4.5 Voluntary quality control
11.5 Monitoring compliance and enforcement mechanisms
11.5.1 Survey/certification and complaint investigation process
11.5.1.1 Surveys and certification
11.5.2 Available sanctions
11.5.2.2 Alternative sanctions
11.5.3.1 Survey process is inconsistent and too lenient
11.5.3.2 Complaint process is inconsistent and too lenient
11.5.3.3 Adversarial process prevents progress
11.5.4 Alternate methods of quality monitoring and improvement
11.5.4.1 Quality Improvement Organization (QIO) Programme
11.5.4.2 Long-term Care Ombudsman Programme
11.6 Market-based approaches to quality control
11.6.1.1 Nursing Home Compare
11.6.1.2 Challenges and evidence to date
11.6.2 Pay-for-performance
11.7 Non-nursing home long-term care regulations
11.7.1 Licensure requirements
11.7.2 Enforcement and compliance
11.7.4 Efficacy of non-nursing home long-term care regulation
11.8 The current state of long-term care regulation and its future
11.8.1 Performance of current long-term care regulatory approach in the US
11.8.2 Costs of regulation
11.8.3 Future of nursing home regulation
12 Long-term care for the elderly in Canada: progress towards an integrated system
12.2 The wider health system context and the roles of government
12.2.1 Ontario healthcare system
12.2.2 Healthcare funding in Ontario
12.2.3 Local Health Integration Networks
12.2.4 LHIN governance and accountability mechanisms
12.2.5 Long-term care settings across the continuum
12.3 Care for the elderly in Ontario
12.3.1 Long-term care homes
12.3.2 Retirement homes and assisted living
12.3.4 Admission and assessment processes
12.3.5 Community Support Agencies
12.3.6 Hospital-based care
12.3.6.1 Complex Continuing Care Hospitals/Units
12.3.6.2 Psychiatric hospitals/units
12.4 Health Information Systems and public reporting across the continuum of care
12.5 Improving quality of care in home care and long-term care
12.5.1 Regulatory framework and inspection of long-term care homes
12.5.1.1 Standards of care, services and programmes
12.5.1.2 Compliance inspection and enforcement
12.5.1.3 Complaints reporting and investigation
12.5.2 Accreditation of health services
12.5.3 Professional associations and quality improvement
12.5.4 Health Quality Ontario
13 Regulating the quality of long-term aged care in New Zealand
13.2 The management of long-term care services
13.3 Long-term care services; home-based and aged residential care
13.3.1 Home-based services and supports
13.3.2 Funding home-based support services
13.3.3 Aged residential care services
13.3.4 Funding residential care services
13.4 Regulation of long-term aged care services
13.4.1 Regulation of home-based support services
13.4.2 Regulatory oversight of home-based support services
13.4.3 Regulation of aged residential care services
13.4.4 Regulatory oversight of residential care services
13.4.5 Consumer choice and voice
13.5 Future long-term care policy directions
13.5.1 Aged residential care
13.5.3 Changing policy directives in assessment
13.6 Monitoring and regulating quality of care
13.6.1 Quality issues in assessment
13.6.2 Quality challenges in community assessment; training, Maori acceptance and software
13.6.3 Quality issues in aged residential care assessment
Part V Long-term care quality systems and developing regulatory systems
14 Quality monitoring of long-term care in the Republic of Korea
14.2 Long-term care insurance
14.2.4.1 Types of services
14.3 Regulatory and inspection system for LTCI providers
14.3.1 Provider certification / market entrance
14.3.2 Oversight of long-term care providers by NHIC
14.3.2.1 Inspection schedule
14.3.2.2 Inspection tools and content
14.3.2.3 Rewards and penalties
14.3.2.4 Evaluation committee
14.3.3 Regulation of the long-term care workforce
14.3.3.1 Geriatric nurses
14.3.3.2 Visiting nurse aides
14.3.3.3 Certified care aides
14.3.4 Information for consumers
14.4 Challenges and conclusion
15 Long-term care in China: reining in market forces through regulatory oversight
15.2 Perfect storm: ageing, socioeconomic changes and the elder care challenge
15.3 Long-term care in the Chinese context: tradition and change
15.4 The rise of formal long-term care for the aged
15.5 Policy engineering: the government’s role in building long-term care services
15.6 Regulatory oversight: central government perspectives
15.6.1 Code for the Design of Buildings for Elderly Persons (guī fàn no. 1)
15.6.2 Basic Standards for Social Welfare Institutions for the Elderly (guī fàn no. 2)
15.6.3 National Occupational Standards for Old-Age Care Workers (One biāo zhǔn)
15.7 Regulatory oversight: challenges for local implementation
15.7.1 Current regulatory structure
15.7.2 Enforcement of regulatory rules is far from rigorous
15.7.3 The tension between conflicting policy goals
15.8 Rising scandals and calls to strengthen regulatory oversight
15.9 Building an information infrastructure
16 Regulating quality of long-term care – what have we learned?
16.2 Long-term care regulatory approaches
16.3 Regulatory centralization or decentralization
16.4 Monitoring long-term care
16.5 The reach of regulatory functions
Regulating Long-Term Care Quality
：An International Comparison
( Health Economics, Policy and Management )
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