Long-term care standards: enforcement and compliance

This paper discusses the regulation of long-term care in the United States. First, it addresses alternate models of regulation that potentially could explain both enforcer and provider actions. Then it describes in more detail the incentives for enforcement of regulatory standards. Empirical evidence concerning the effect of regulation on provider incomes and the reltionship between reported compliance with standards and provider operating costs is examined. In the latter case, the evidence is consistent with a self-interest theory of behavior for regulatory agencies and inspectors. Ideas for reform of the long-term care marketplace are summarized in the concluding section, with emphasis on their probable impact on enforcement of standards.