Quality of care in unlicensed homes for the aged in the Eastern Townships of Quebec

Background: The recent proliferation of unlicensed homes for the aged in Qu ebec, coupled with the increased needs of the population they serve, has ra ised concerns about the quality of care these homes provide. The authors co mpared the quality of care in unlicensed homes with that in licensed long-t erm care facilities in a region of Quebec. Methods: The study involved 301 impaired people aged 65 and over in 88 resi dential care facilities (52 unlicensed, 36 licensed) in the Eastern Townshi ps of Quebec. Study participants were chosen according to a 2-stage samplin g scheme: stratified sampling of the primary units (facilities) and random sampling of the secondary units (residents). Quality of care was measured u sing the QUALCARE scale, a multidimensional instrument that uses a 5-point scale to assess 6 dimensions of care: environmental, physical, medical mana gement, psychosocial, human rights and financial. A mean score of more than 2 was considered indicative of inadequate care. Results: Overall, the quality of care was similar in the unlicensed and lic ensed facilities (mean global score 1.61 [standard error of the mean (SEM) 0.06] and 1.47 [SEM 0.09] respectively). Examination of dimension-specific quality-of-care scores revealed that the unlicensed homes performed worse t han the licensed facilities in 2 areas of care: physical care (mean score 1 .80 [SEM 0.08] v. 1.51 [SEM 0.09] respectively, p = 0.017) and medical mana gement (1.37 [SEM 0.06] v. 1.14 [SEM 0.05], p = 0.004). The dimension-speci fic scores also revealed that both types of homes lacked appropriate attent ion to the psychosocial aspect of care. Overall, 25% of the facilities prov ided inadequate care to at least one resident. This situation was especiall y prevalent among homes with fewer than 40 residents, where up to 20% of th e residents received inadequate-care. Interpretation: Most of the unlicensed homes for the aged that were studied delivered care of relatively good quality. However, some clearly provided inadequate care.