In this thesis, the overall purpose was to investigate the role of regulation in the care of older people with depression living in long-term care (LTC).
The first manuscript in this thesis is a systematic scoping review protocol which was published in BMJ open, using Arksey and O'Malley's scoping review methodology as a guide. In the second manuscript which was submitted to BMC Geriatrics, a systematic scoping review was conducted, exploring the concepts of regulation, older people, depression, and long-term care. The search yielded 778 unique articles, of which 21 were included in the final analysis. The scoping review revealed that the highly regulated environment of LTC poses significant challenges which can influence the quality of care of residents with depression. Despite evidence of high prevalence and improved treatment, regulation appears to have failed to capture best practice and contemporary knowledge. The scoping review demonstrated a need for further empirical research to explore these issues.
Findings from this study, which explored the role of regulation on the quality of care of older people living with depression in LTC are presented, and which were the basis of the third manuscript, to the Canadian Journal of Aging. Using instrumental case study methodology, I interviewed managers, staff, informal carers and residents, and reviewed documents and clinical charts. I found that Ministry of Health and Long-Term Care regulations influenced strategic planning, educational priorities, resourcing decisions and direct care. The findings from the study suggest an alternative approach to regulation is needed in this sector, which places accountability for standards of care at a provincial level and which has a more supportive and collaborative approach to regulations. The research findings showed that the staff working in the LTC home are committed to the care of residents with depression, but they had little time to implement additional quality initiatives outside of the identified mandated areas. The study concludes by suggesting that in its current state, the care of residents with depression in LTC homes is not reflected in Ministry of Health and Long-Term Care regulations and inspections, which make little difference to the care of older people living with depression living in LTC.
In contributing to the existing knowledge and practice the study along with the findings from the scoping review, finds an alternative model of inspection could be implemented in partnership with the province. An alternative approach to inspection might adopt an extended approach to quality, along with an individualized approach to inspections to meet the requirements set out in regulation, but at the same time offering flexibility and a more collaborative approach to improving quality in the LTC sector.
| Identifer | oai:union.ndltd.org:uottawa.ca/oai:ruor.uottawa.ca:10393/39114 |
| Date | 29 April 2019 |
| Creators | Crick, Michelle |
| Contributors | Backman, Chantal Eva |
| Publisher | Université d'Ottawa / University of Ottawa |
| Source Sets | Université d’Ottawa |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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