Approaches to accountability in city of Toronto long-term care homes
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Within the context of healthcare accountability are concepts such as quality and safety of care, resource allocation and the notion of value for money. When understanding accountability, questions such as who is accountable for what and how is accountability demonstrated arise. As the number of stakeholders and funders increase, and in a highly regulated long-term care sector, the answers to these questions increase in complexity. The goal of this study is to examine the approaches to accountability within ten homes that are publicly funded and publicly delivered by the City of Toronto, within a framework of accountability mechanisms including financial oversight, regulations and information, and professionalism. A case study research design, with both document review and semi-structured interviews, was utilized to understand the implications of key variables on the framework to evaluate accountability. The results are based on seven informants from publicly funded and delivered homes in the province of Ontario both from senior management and long-term care home administrators. The dominant mechanisms of accountability found in this research are financial oversight, regulations, and information, while professionalism played a marginal role. Key informants identified the challenges of being accountable to multiple funders, including five LHINs and to the City of Toronto. The increased need to be compliant with legislation requirements, LHIN performance indicators, and ensure high-quality resident care is not consistent with the finite and decreasing resources required to successfully demonstrate accountability to multiple stakeholders.