Regulation and quality in aged care: A cross-national perspective

The objective of this article is to assess critically the regulatory foundations required for continuous improvement in the quality of nursing home care. Data from observation of nursing home inspections in Australia and other nations (particularly the US) are used to illuminate this assessment. Conclusions are: The quality of regulatory dialogue affects care outcomes: disrespectful dialogue and tolerance of law-breaking make things worse. Trustful dialogue, praise, reintegrative shaming and building the self-efficacy of managers improves compliance. A useful policy framework is a regulatory pyramid that tries dialogue first and then escalates to more sanction-based strategies when dialogue fails. Attempts to pursue consistency in regulatory decisions by rendering rules more specific and disciplining them with scientific protocols is counterproductive because of the operation of a 'reliability paradox'.