Regulation in aged care ‘should leave room for innovation’
As our study into the role and effects of regulation in aged and dementia care enters its final stages, some interesting findings are emerging, write Ashley Carr and Professor Simon Biggs.
Amid concerns that the regulation of care stifles creativity and innovation or that recipients of aged care require greater levels of protection, a more in-depth understanding of why we regulate care, and what its real effects are, is needed.
This is the aim of our study currently underway on the role and effects of regulation in aged and dementia care.
The research is a three-year study supported by the Cognitive Decline Partnership, a national partnership initiative funded by the NHMRC, Alzheimer’s Australia and three aged care providers, Brightwater Care Group, Helping Hand Aged Care and HammondCare.
As the study approaches its final stages some interesting findings are emerging.
During the early stages of research we mapped the regulatory system to reveal the uneven spread of regulation throughout the system, showing how regulation clusters around particular individuals, care sites and care-related activities.
This clustering takes place in four ways:
through the overlap and duplication of different government responsibilities, jurisdictions and regulatory authorities
by accretion as more regulation has been added over time in response to risk, scandal and system failings
the interplay of multiple regulations at care transition points
differing levels of regulation depending on the care activity.
While these findings may come as no surprise to those involved in aged and dementia care, they provide evidence on where resources and efforts to improve care amidst regulation are best targeted.
For instance, the web of regulations marking the transition into residential care suggests a point where care-users require more support, while flexibility and innovation in care appears more likely in areas where there are less prescriptive rules. In contrast, overlap and duplication is a consequence of Australia’s federal system, the fragmentation of care provision and the evolution of the system, and is more appropriately addressed at the national political level.
Our research is now using and expanding these findings to explore the different ways aged care provider organisations respond to the regulatory environment. Interviews with senior managers, facility managers and care workers (PCA or equivalent) across a range of residential care settings have been conducted.
They reveal how the interpretation and application of regulation differs at three distinct levels of the organisation. The various organisational and operational strategies developed to translate regulation into action are currently being examined, and will form the basis of planned dissemination activities. Significantly, future publications will outline how organisational strategies and approaches to regulation reveal what is specific about dementia care and thus its regulation.
Coming into the final stages of the project our research will turn its focus to the experience of care-users, and collect information on what this stakeholder group see as the pros and cons of regulation. This stage of the research, alongside ongoing work with the care provider partners and other stakeholders, will help to shape a series of policy and practice recommendations.
Overall, the most important message of our research is that debates about more versus less, good versus bad regulation fails to capture the complexity of care governance, the need to balance various stakeholder interests and the various ways regulation can both enable and prohibit different aspects of care practice.
Moreover, ‘good’ regulation should leave room for innovation while maintaining the ‘intent’ behind regulatory rules.
In the context of proposals for a lighter touch approach to regulation we would do well to recognise the critical role of regulation in mixed economy care and recognise both its benefits and drawbacks.
Ashley Carr and Professor Simon Biggs work for the University of Melbourne and the Brotherhood of St Laurence.