# What Gets Measured Gets Counted: Food, Nutrition, and Hydration Non-Compliance in Ontario Long-Term Care Homes and the Role of Proactive Compliance Inspections, 2024

## TL;DR

This study finds that using a specific food and nutrition inspection protocol in Ontario long-term care homes increases the detection of non-compliance issues.

## Contribution

The study provides the first province-wide analysis of food, nutrition, and hydration non-compliance in Ontario long-term care homes.

## Key findings

- FNH non-compliance was found in 12.2% of all long-term care homes.
- Using the FNH inspection protocol was associated with a higher likelihood of detecting non-compliance.
- LTCH ownership and inspection type influenced detection patterns of non-compliance.

## Abstract

Food and nutrition services are critical to the health of long-term care home (LTCH) residents, yet little is known about how regulatory inspections detect non-compliance with Food, Nutrition, and Hydration (FNH) standards. We conducted a cross-sectional study of administrative inspection data from all licensed LTCHs in Ontario, Canada. One inspection report was randomly selected per LTCH, yielding a sample of 623 LTCHs. The data were collected for the period spanning 1 January 2024 to 31 December 2024. The primary exposure was use of the FNH inspection protocol, and the outcome was FNH non-compliance, defined as at least one Written Notification or Compliance Order. Statistical analyses included chi-square tests for categorical variables and independent samples t-tests (including Welch’s t-tests where appropriate) for continuous variables, with effect sizes (Φ, Cramer’s V, Cohen’s d) reported to complement p-values. This study did not require research ethics review under Western University policy, consistent with Canada’s Tri-Council Policy Statement (TCPS 2, Article 2.2) regarding use of publicly available data. FNH non-compliance was identified in 12.2% (n = 76) of all LTCHs, and in 43.7% of those using the FNH protocol. Use of the FNH protocol was associated with a higher likelihood of detecting FNH non-compliance compared with other inspection protocols (p < 0.001, Φ = 0.55). LTCH ownership and inspection type were also associated with detection patterns. This exploratory study provides the first province-wide analysis of FNH non-compliance in Ontario LTCHs. Findings suggest that inspection protocols influence detection of FNH issues, underscoring the need for further comparative and qualitative research to understand the organizational factors underlying non-compliance.