Systemic failures in nursing home care-A scoping study.

Area of Science:

• Gerontology and Health Services Research
• Organizational Studies
• Public Policy

Background:

• Nursing homes, or residential aged care facilities, face global challenges balancing resident needs, regulatory demands, and financial imperatives.
• This systemic tension often leads to a lack of clarity regarding the facility's core purpose, potentially causing dysfunction across all organizational levels.

Purpose of the Study:

• To conduct a scoping study synthesizing existing knowledge on systemic functions and failures within the nursing home sector.
• To analyze the impact of these systemic issues on the broader health and aged care landscape.

Main Methods:

• Searched MEDLINE, EMBASE, PSYCHINFO, CINAHL, and SCOPUS for system-focused articles up to February 2021.
• Included snowballing of references and grey literature searches.
• Defined system-focused articles as those examining inter-level impacts or impacts on multiple agents at the same level.

Main Results:

• Analyzed 38 articles across the US, Canada, Australia, and Europe, identifying 29 key systemic issues across five layers.
• Found that only four studies reported whole-of-system findings.
• Negative outcomes include regulatory reprimands, resident/family/staff dissatisfaction, and a negative perception of nursing homes as workplaces.

Conclusions:

• Key systemic issues in nursing homes arise from a lack of shared purpose and inadequate national governance/accountability frameworks.
• Redesigning the nursing home system requires addressing these core issues to achieve integration and desired resident outcomes.
• Implementing 'systems thinking' is essential for simultaneously enhancing care quality, strengthening regulation, and ensuring financial viability.