A regulatory framework is the backbone of any responsible aged or healthcare system. Considered, enforceable approaches and measurable, reportable standards are necessary for maintaining high quality and transparency, and meeting community expectations.
But when does a system become over-regulated?
One of Canada’s most influential voices for older people – Dr Samir Sinha – has seen that pendulum swing in his own country.
“Regulations sometimes don’t produce what we want for people with dementia,” says Sinha, who will address this topic as a keynote speaker at the International Dementia Conference in September.
“The over-regulation of aged care and the management of risks that come with it – where the ultimate goal is safety – can result in a situation where people end up merely as a list of boxes to be ticked, rather than as humans.”
Sinha – director of geriatrics at Toronto’s Sinai Health – is a highly regarded clinician and international expert in the care of older adults, who has decades of experience guiding government policy on aged care.
During the Covid pandemic, Canada led the world in deaths in long-term care, which started a national movement to change the system.
Sinha has been hands-on at both the care coalface, as Director of Geriatrics of the Sinai Health System, and as a member of various senior government advisory groups.
He’s seen close-up how governments can over-correct, burdening an already under-staffed sector, and ultimately, reducing quality of life for those in their care.
“Any time there’s something on the news about someone getting hurt, there are more regulations introduced, and practices become more risk-averse,” says Sinha.
“Instead, risk appetite needs to be matured and nurtured and encompass the right for people to live with risk.”
And the most impactful solution isn’t regulations, according to Sinha, but it can be summed up in one word – staffing.
“If you have enough staff, you have a fighting chance that people will get appropriate relationship-centred care, not tick-a-box care,” he says.
“If you really want to deliver high quality-care, you need to give residential homes a chance by allowing them to staff themselves adequately.
“Pay parity for well-trained and well-supported staff will lead to the provision of better resident-centred care.”
It is difficult to identify and address long-term care issues
Dr Sinha believes that the other key to a more nuanced and mature regulatory framework is a better integrated health care data collection system for the purpose of quality and safety monitoring.
In a report called Enhancing Care for Older Adults in Canada and Down Under published by Canada’s National Institute on Ageing earlier this year, he argues that Australia could learn from his own country’s experience by implementing a national, multi-purpose, comprehensive and integrated data collection toolkit system, such as InterRAI.
“Without consistent measurement and cohesive data, it is difficult to identify and address long-term care issues such as the provision of substandard care,” says Sinha in the report.
He adds that although progress has been made regarding the public reporting of quality indicators and provision of star ratings for long-term care homes, it’s not enough.
“It remains difficult to measure the overall quality of long-term care services in Australia because there is no standardised system of data collection or centralised storage of information about needs, service use or care outcomes,” he says.
Angela Raguz is general manager of The Dementia Centre
Dr Samir Sinha will address these topics further at the International Dementia Conference, which takes place 5-6 September 2024 at the Hilton Hotel, Sydney
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