Concepts and strategies of quality assurance in care for older people

In the context of globally rising life expectancy the concepts of quality of care and quality of life need to be redefined for older people who need long-term care at some stage of their lives. To ensure access, sustainability of staffing and funding as well as the quality of facilities and services will be one of the greatest challenges for cultures of care and caregiving during the next decades. This chapter is shedding light on these challenges by focusing on issues of quality assurance in services for older people who have to rely on long-term care. The specific challenge of long-term care as an emerging system between health and social care is to balance not only the cleavages between the different organisational cultures of health and social care but in particular the tensions at the interface of the ‘system’ and ‘life world’ (Habermas). In the light of changing paradigms of health with concomitantly changing concepts of the welfare state the first part of this chapter draws a picture of how care quality can or should be conceived to appropriately address the idiosyncrasies of long-term care for older people. The second part outlines strategies that have been implemented to ensure quality of care, taking into account the different perspectives of professional care workers (‘quality by professional ethics’), but also by informal carers and older people who are in need of care (‘quality by voice, exit and choice’). The resulting tensions in current and future care quality are discussed, including some strategies that show, how policies (‘quality by market-oriented regulation and inspection’) and provider organisations (‘quality by management’) try to face the challenges to define, assess, secure and improve quality. The chapter will conclude with a brief outline of future perspectives on quality in long-term care with a focus on quality of life and continuous improvement in empowering and ‘learning’ organisations.