Centring Care: Explaining Regulatory Tensions in Residential Care for Older Persons

Abstract

Residential care is a highly regulated sector. Regulations are often a product of scandal, and they reflect an understandable desire to safeguard nursing homes’ vulnerable populations. However, research on Ontario nursing homes reveals significant tensions between regulations and care. Regulations, and the reporting they require, take valuable time away from care, often fail to account for the relational aspects of care, and disempower residents while empowering paperwork. This article describes and seeks to explain these tensions. We find that the current style of regulating follows the logic of neoliberal auditing. This evidences a top-down approach to accountability, which is reductive in nature and focuses on facilities, care workers, and care processes. It thus misses the structural aspects of care that set the conditions for care—funding, ownership, and staffing levels. We do not argue against regulation nor, necessarily, auditing. Rather, we recognize the importance of distinguishing levels of regulation, and make reference to research suggesting that structural regulations need to be prioritized.