Relationship between Regulatory Status, Quality of Care, and Three-Year Mortality in Canadian Residential Care Facilities: A Longitudinal Study


  • Gina Bravo,

  • Marie-France Dubois,

  • Philippe De Wals,

  • Réjean Hébert,

  • Lise Messier

  • This research was funded by grant no. 6605-05-1998/2590036 from Health Canada.

Address correspondence to Gina Bravo, Ph.D., Research Centre on Aging, Sherbrooke University Geriatric Institute, 1036 Belvedere South, Sherbrooke, Quebec, Canada, J1H 4C4. Dr. Bravo is also with the Department of Community Health Sciences at Sherbrooke. Marie-France Dubois, Ph.D., and Philippe De Wals, M.D., Ph.D., are also with the Research Centre on Aging and the Department of Community Health Sciences at Sherbrooke University. Réjean Hébert, M.D., M.Phil., and Lise Messier, B.N., are with the Research Centre on Aging, Sherbrooke. Dr. Hébert is also with the Department of Family Medicine, Sherbrooke.


Objectives. To compare the mortality rate in regulated and unregulated facilities, controlling for confounding variables, and investigate the effect of care quality on residents' length of survival.

Data Sources/Study Setting. At baseline, subjects were assessed in their living environment with respect to their functional autonomy, cognitive abilities, and quality of care. Vital status, disease-related information, and hospitalization data were retrieved three years later from the subjects' medical files.

Study Design. A three-year follow-up study of 299 residents from 88 long-term care facilities located in the province of Quebec, Canada. The effect of regulatory status and quality of care on length of survival was investigated by means of multivariable Cox proportional hazards regression models, from both traditional and competing risks perspectives.

Principal Findings. Controlling for age, comorbidity, and baseline functional abilities, a resident's length of survival is not significantly influenced by the regulatory status of the facility in which he or she lived at baseline. However, residents with poor quality ratings at baseline had shorter survival times than those provided with good care. Median survival was 28 months among residents classified as receiving inadequate care compared to 41 months for those adequately cared for (p=0.0217).

Conclusions. The study suggests that quality of care has a much stronger influence on resident outcomes than regulation per se. This finding underscores the relevance of testing innovative interventions aimed at improving the quality of care provided in long-term care facilities, regardless of their regulatory status.