Organizational Factors Associated with Regulation Noncompliance in Home Care Services and Service Housing Facilities: An Exploratory Cross-Sectional Study

. Rationale . Recent studies have highlighted organizational issues, work stressors, and moral distress as prevalent problems among staf working within care services for older people, but factors infuencing regulatory compliance in care services for older people are currently uncharted. Aims and Objectives . Te aim of this exploratory study was to investigate how organizational factors, the clinical characteristics of the clients, and perceived organizational factors are associated with staf regulation noncompliance within home care services and service housing facilities. Methods . A self-report survey was sent to practical and registered nurses working in home care services and service housing in Finland in October 2021. Te sample consisted of 352 home care and 555 service housing staf members. Separate models were calculated for home care services and service housing facilities. Te data were analyzed using logistic regression models. CROSS reporting guidelines were followed. Results . Te results show that in service housing facilities, higher numbers of disruptions, lower team autonomy, and working for a private employer increased the odds of regulation noncompliance. In home care services, higher numbers of visits during a day, higher numbers of disruptions, and lower team autonomy increased the odds of regulation noncompliance, while attending to clients requiring less resources decreased the odds of regulation noncompliance. Perceived lack of time and resources were infuential factors in both contexts. Conclusion . Allocating more time to attend to tasks, ensuring adequate stafng, as well as supporting team autonomy, may increase regulation compliance within care services for older people.


Introduction
As the number of older people is expected to increase, recruiting and retaining staf within care services has become of pivotal importance [1,2].However, during the past years, it has been reported that work satisfaction among care staf has been decreasing, with sickness absences and reported work strain and stress increasing [3].Furthermore, there have been increased concerns related to the workforce shortage of care workers, especially in the long-term care settings, due to the aging of the workforce, poor working conditions, limited training and career development opportunities, high turnover rates, and insufcient social recognition [1,4].While many factors associated with work dissatisfaction and workforce shortage among care services for older people are related to organizational factors, studies have also highlighted moral distress and ethical conficts as a prevalent problem among staf within care services for older people [3,5,6].
Regulation has been defned by Selznick as "sustained and focused control exercised by a public agency over activities that are valued by the community" [7].In healthcare settings, regulations are often formulated for the protection of the clients and to ensure quality of care and are often embedded in local legislature [8,9].Regulatory failure, or noncompliance, refers to the violation of the regulations and may be due to several reasons, such as, but not limited to, the environment and culture of the organization, management practices, and staf characteristics and attitudes [10,11].Regulation noncompliance in healthcare settings may contribute to both reduced quality of care and ethical and moral distress for staf members, especially if the reasons for noncompliance are due to structural and/or organizational hinders that inhibit one from working according to either personal ethics or the rules of the organization.
Previous studies on regulatory compliance in the setting of care for older people are few.A study on cutting corners, which refers to deliberate violations or deviations from established rules, norms, or procedures, among nurses working in various healthcare settings showed that cutting corners was described as common practice, often done to manage the workload, or to prioritize the health and wellbeing of patients in emergency situations [12].An older study on nurse's aides in the nursing home setting found that nurse's aides often had to increase the efciency of their work by planning in advance, cut corners due to a lack of time, and break rules to either increase efciency or enhance perceived quality of care [13].Furthermore, studies on noncompliance to guidelines within clinical healthcare settings have revealed lack of support from management, poor communication of management, lack of involvement in decision making, lacking resources, ambiguity concerning responsibilities, and hierarchical structures, as described reasons behind noncompliance to guidelines [14,15].
Previous study has illuminated factors related to working conditions, such as time pressure, stress, and increasing administrative demands as factors that increase occupational stress and result in staf not being able to provide the type of care they would wish to [16].Research on the concepts of unmet care needs and care poverty, referring to unfulflled healthcare needs due to socioeconomic and demographic factors or policy-level failure due to lack of resources, has also increasingly emerged during the past decades [17,18], underlining the signifcance of organizational factors, understood as factors, processes, or conditions relating to the organization [19], to the quality of care provided.Te working conditions in home care services have also recently been described as more hectic, as the number of older people receiving home care services has increased during the past decades in Finland, but the number of staf has not increased equivalently [20].Despite these signifcant organizational changes over the years, there has been very limited study into regulatory compliance within care services for older people.
Donabedian describes quality of care as a system of structures, processes, and outcomes [21,22].Structures refer to organizational characteristics, such as facilities, fnancing, and stafng, which are related to, and have infuence on, the processes and outcomes [21,22].Exploring the relationship between organizational factors, perceived organizational factors, and regulation noncompliance may therefore illuminate potential structural hinders to the actualization of the regulations formulated to ensure quality of care.Exploring the clinical characteristics of clients and the allocated care time in relation to the clients' clinical characteristics may further illuminate if and how the clinical status of clients' is associated with regulation noncompliance, and if the allocated resources are sufcient to address clients' needs in a manner that permits regulatory compliance.Investigation of these factors may illuminate internal hinders to regulatory compliance and assist in the planning and implementation of tasks and work management.Furthermore, supporting regulatory compliance of staf may support staf retention, enhance client safety and care continuity, and improve both the quality of care and the working conditions of staf.

Aim and Research Questions
Te aim of this exploratory study was to investigate how organizational factors, the clinical characteristics of the clients, and perceived organizational factors are associated with staf regulation noncompliance within home care services and service housing facilities.Te research questions were as follows: (1) How is the number of clients, amount of indirect care time, number of disruptions, clinical complexity of clients, the care time in relation to clinical complexity, team autonomy, and working for a private employer associated with regulation noncompliance of staf working within service housing facilities providing 24-hour assistance?(2) How is the number of visits, amount of indirect care time, number of disruptions, clinical complexity of clients, the care time in relation to clinical complexity, and team autonomy associated with regulation noncompliance of staf working within home care services?(3) How is perceived lack of time and resources associated with regulation noncompliance of staf working within service housing facilities providing 24-hour assistance and home care services?Te Staf Time Measurement study took place in October 2021 and consisted of three surveys: the Time Measurement Survey, in which the staf listed the duration of tasks during their working day; a Wellbeing Survey that measured staf perceptions regarding wellbeing and work satisfaction; and a Manager Survey, in which managers provided information on organizational factors, such as task planning and autonomy of staf.For the Time Measurement Survey, each respondent listed the duration of diferent tasks from a list of ready options (e.g., assisting with hygiene, medication, documentation, and travel time).Time allocation was followed during one day in service housing facilities and seven days in home care services.Home care service staf responded to the Wellbeing Survey during the frst working day.Each participating organization/unit was provided written instructions, access to a video with information on the survey, and instructions for flling the paper survey.Online training sessions were also arranged for the participating organizations/units.All care staf working in the organizations participating in the Staf Time Measurement study were invited to participate in the Time Measurement Survey and Wellbeing study, and staf were permitted to complete the survey during working hours.

Methods
Te Wellbeing Survey was an additional survey for the staf of units participating in the Time Measurement study.Te Wellbeing Survey consisted of a before part, with questions to be answered before the working shift on when the respondent had their last shift and how they have slept.Te after part of the Wellbeing Survey, to be answered after the working shift, consisted of questions about perceptions about the working day.
Each staf member that participated in the study was supplied with an anonymized identifcation number, and demographic information on the respondents, their clients, and the organization was obtained from the Resident Assessment Instrument (RAI) registries.Te RAI registries are maintained by the Finnish Institute for Health and Welfare and consist of data on care services for older people for quality assessment purposes.Te RAI registry data were combined with the study data to explore how the clients' clinical characteristics are associated with regulatory compliance.Only registered nurses and practical nurses were selected for the sample of this study.Other staf members were excluded due to the limited amount of time these staf members spend with clients and small sample sizes (<50).Tis study is reported in compliance with the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) checklist (Supplementary fle 1).

Study Variables. Data from the Time Measurement
Survey, the Wellbeing Survey, the Manager Survey, and RAI registry data were utilized for this study.Te surveys contained data on time allocation within care services, numbers of clients, staf perceptions of the shift, and team autonomy.Te RAI registry contained data on the clinical characteristics of clients the staf had attended to.Amount of indirect care time provided, number of disruptions, the number of diferent clients attended to by each participant during the shift (in service housing), the number of home visits the participants had during the shift (in home care services), clinical complexity of clients, care time in relation to clinical complexity, team autonomy, and working for a public/ private organization (service housing only), perceived lack of time, and perceived lack of resources were included as independent variables to explore the signifcance of these factors to regulatory compliance.Te question related to regulatory compliance from the Wellbeing Survey was included as the dependent variable (Table 1).

Regulatory Compliance.
Te question on regulatory compliance was adapted from Rizzo et al.'s role confict and ambiguity scales [25].For this study, the question on regulation compliance from the before/after survey ("In some situations I had to violate regulations to get my job done") was dichotomized as the distribution of the responses was skewed.In the dichotomized variable 0 indicated that the staf member perceived that they were able to completely comply to regulations, and 1 indicated that, to diferent degrees, the staf member perceived that they violated regulations during their working shift.Rizzo et al.'s role confict and ambiguity scales have shown good validity and reliability, with Cronbach Alpha values between 0.64 and 0.85 [26,27] and between 0.70 and 0.82 in the Finnish context [28].
3.4.Indirect Care Time.Indirect care time was measured by combining the number of minutes staf reported to have spent doing tasks related to indirect care (defned as work done without the clients present, e.g., documentation at the ofce, updating care plans).Tis resulted in a sum score of minutes per day of indirect care allocated by staf.For home care services, where time allocation was followed for seven days, the combined values for seven days were divided by seven, to obtain a mean value for one day.

Number of Disruptions. Number of disruptions was
measured by having the staf mark if disruptions (such as sudden emergencies and unexpected events) occurred during their working shift.Te total number of disruptions was then converted into a variable to indicate the number of disruptions during one working day.

Number of Clients/Number of Visits.
Due to contextual diferences between home care services and service housing facilities, the number of unique clients was added as an independent variable in service housing facilities, while in Health & Social Care in the Community 3.8.1.Team Autonomy.Team autonomy was measured by combining seven items from the Manager Survey and calculating the mean value (Cronbach's Alpha 0.76).Tese seven items were questions related to whether staf was able to decide independently within their team about their work planning, client visits, recruitment, use of substitute workers, working methods, care of clients, and participation in education to promote professional competence.Te questions were scored on a 1-to 4-point Likert scale, with 1 indicating "not at all" to 4 "the team can decide fully independently." Working for a Public/Private Organization.Te variable working for a public/private organization was only included in models concerning service housing facilities, as all included home care organizations were public.

Perceived Lack of Time and Perceived Lack of Resources.
Perceived lack of time and perceived lack of resources were measured by asking respondents after their working day if they felt they had a lack of time to do their job properly, and if they felt they were assigned tasks without being provided the tools and/or resources to complete the tasks.Tese questions were adapted from the Harris Nurse Stress Index and Rizzo et al.'s rule confict and ambiguity scales [25,31].Te questions were scored on a 1-to 5-point Likert scale: 1 indicated disagreement and 5 indicated full agreement with the statement.
3.9.Statistical Analysis.Descriptive statistics were utilized to explore the data and describe the demographic data.To explore associations between the dependent and independent variables, correlations, chi-square tests, and independent sample t-tests were utilized.To explore the potentially nested nature of the data, mixed-efects regression models were performed to explore how belonging to specifc organizations and teams is associated with responses.Tese analyses showed intraclass correlation values of <0.03 for home care services and <0.10 for service housing, indicating high individual variability within groups [32].Terefore, logistic regression models with the dependent variable regulatory compliance and the independent variables clinical complexity of clients, number of clients/visits (service housing/home care), indirect care time, number of disruptions, care time in relation to clinical complexity, and working for a private employer (only service housing) were performed to explore factors that are associated with regulation noncompliance.To explore how perceived factors are associated with regulatory compliance, separate models were performed including the variables listed above and adding the variables perceived lack of time and perceived lack of resources.Models were calculated for both service housing facilities and home care services separately.Te linearity of the continuous variables with respect to the logit of the dependent variable was assessed using the Box-Tidwell procedure.Te continuous independent variables were found to be linearly related to the logit of the dependent variable.Goodness of ft of the logistic regression model was assessed using the Hosmer-Lemeshow test (p ≥ 0.05).Standardized residuals were examined to identify potentially infuential outliers.Te percentages of item-level missing values varied from 1.3%-5.6%.Te team autonomy scale had 7.3% missing values; this may be due to the smaller sample size, as these data were provided by the managers of the participating units (n � 17).No imputations were done to the data.A reference population of 47,000, based on the total number of staf working daily in home care services/nursing homes in Finland, was used to calculate the sample size.Te power level for this study was set to be 95% with a 0.05 signifcance level, resulting in a minimum required sample size of 385.Statistical signifcance was defned as p < 0.05.SPSS version 29 was used for the statistical analyses.

Ethical Considerations.
Te study was approved by the Finnish Institute for Health and Welfare Ethical Review Board (THL/1447/6.02.01/2021).All participants were Health & Social Care in the Community informed of their rights; that participation in the study is voluntary and that they may withdraw their participation at any time without justifcation or consequences.Te data have been stored in compliance with data regulations, and the study was conducted according to the ethical principles of the Declaration of Helsinki [33].

Demographic Data.
Te response rate for the Wellbeing Survey was 90.1%.Te total sample of this study consisted of 907 respondents.Of these respondents, 352 worked in home care services: 50 were registered nurses and 302 practical nurses.Te mean age of those working in home care services was 43.2, and 92.3% of respondents were female.Of those working in home care services, 24.4% reported that in some situations, they violated regulations to get their job done.
Of the total study sample, 555 respondents worked in service housing facilities: 89 were registered nurses and 466 practical nurses.Te mean age of those working in service housing facilities was 44.6, and 92.6% of respondents were females.Of those working in home care services, 25.9% reported that in some situations, they violated regulations to get their job done.Furthermore, information may be found in Table 2.

Variables Explaining Regulatory Compliance in Service
Housing Facilities.Regression model 1 was performed to explore how number of clients, amount of indirect care time, number of disruptions, clinical complexity of clients, the care time in relation to clinical complexity, team autonomy, and working for a private employer are associated with regulatory compliance in service housing facilities.Te full model containing seven independent variables was statistically signifcant χ 2 (7, N � 555 � 27.309, p < 0.001), indicating that the model was able to distinguish between those who had not complied to regulations and those who had.Tree variables made a statistically signifcant contribution to the model: number of disruptions, team autonomy, and working for a private employer.Te odds ratios indicate that a higher numbers of disruptions, lower team autonomy, and working for a private employer increase the odds of regulation noncompliance in service housing facilities.
For regression model 2, perceived lack of time and perceived lack of resources were added to regression model 1.Te full model containing nine independent variables was statistically signifcant χ 2 (9, N � 555 � 180.135, p ≤ 0.001).Two variables made a statistically signifcant contribution to the model: perceived lack of time and perceived lack of resources.Te odds ratios indicate that higher perceived lack of time and higher perceived lack of resources increases the odds of regulation noncompliance in service housing facilities (Table 3).

Variables Explaining Regulatory Compliance in Home
Care Services.Regression model 3 was performed to explore how number of visits, amount of indirect care time, number of disruptions, clinical complexity of clients, the care time in relation to clinical complexity, and team autonomy are associated with regulatory compliance in home care services.Te full model containing six independent variables was statistically signifcant χ 2 (6, N � 352 � 23.469, p ≤ 0.001).Four variables made a statistically signifcant contribution to the model: number of visits, clinical complexity of clients, number of disruptions, and team autonomy.Te odds ratios indicate that higher numbers of visits during a day, higher numbers of disruptions, and lower team autonomy increased the odds of regulation noncompliance, while attending to clients requiring less resources decreased the odds of regulation noncompliance in home care services.
For regression model 4, perceived lack of time and perceived lack of resources were added to regression model 3. Te full model containing seven independent variables was statistically signifcant χ 2 (7, N � 352 � 27.309, p ≤ 0.001).Tree variables made a statistically signifcant contribution to the model: clinical complexity of clients, perceived lack of time, and perceived lack of resources.Te odds ratios indicate that caring for clients requiring less resources decreased regulation noncompliance, while higher amounts of perceived lack of time and higher amounts of perceived lack of resources increased the odds of regulation noncompliance in home care services (Table 4).

Discussion
Te aim of this study was to investigate how organizational factors, the clinical characteristics of the clients, and perceived organizational factors are associated with regulation noncompliance within home care services and service housing facilities.In service housing facilities, higher numbers of disruptions, lower team autonomy, and working for a private employer increased the odds of regulation noncompliance.In home care services, higher numbers of visits during a day, higher numbers of disruptions, and lower team autonomy increased the odds of regulation noncompliance, while attending to clients requiring less resources decreased the odds of regulation noncompliance.Perceived lack of time and resources increased odds of regulation noncompliance in both service housing facilities and home care services.
In service housing facilities, working for a private employer increased the odds of regulation noncompliance; however, previous investigation on diferences between private and public sector care of older people in Finland showed better stafng, higher client satisfaction, and shorter intervals between meals in private care services [34], indicating that further research is needed to identify factors and reasons for diferences between private/public sector facilities.Interestingly, the clinical complexity of clients and the care time in relation to clinical complexity showed no statistical signifcance to regulation noncompliance in service housing facilities, while the perception of lack of time and resources was signifcant.Care time in relation to clinical complexity only indicates if clients receive the clinically required time for care, and does not take into consideration, for example, the psycho-social aspects of care.

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Health & Social Care in the Community Terefore, although clients may receive a clinically adequate amount of time, this time may difer from what is perceived as an appropriate amount of care time.Tese results align with previous studies indicating lack of resources leading to care poverty [17,18], and raise questions as to if the amount of time allocated for care is currently enough to provide care that is perceived as sufcient.It is possible that regulation noncompliance in service housing facilities may be due to a lack of resources and opportunities to work in a way that facilitates both the opportunity to comply to professional and personal moral codes, and the regulations of the organizations.
In home care services, the clinical complexity of clients showed a statistically signifcant, negative, contribution to the model.Tis result indicates that caring for clients, requiring less resources decreases the odds of regulation noncompliance in home care services.Tis may be due to the limited amounts of time home care services have to attend to those requiring more resources, as a previous study on the same sample showed that clients with higher levels of ADL receive almost half the amount of care time in home care services, compared to clients with similar levels of ADL in service housing facilities [23].It is possible that due to time restraints, home care staf may need to cut corners and violate regulations when attending to clients with higher care needs, especially as higher numbers of visits were also signifcantly associated with regulation noncompliance.Tese results may also, to some extent, be due to lower stafng levels in home care services, as there are no regulations concerning minimum stafng in home care services, as there are in service housing facilities in Finland [24].It is also possible there is not enough staf to assist in, for example, lifting or moving clinically complex home care clients, resulting in regulation noncompliance.Previous study on nurses' aides has shown that cutting corners and breaking rules were practices done out of necessity due to time restraints, and in some cases planned so that the minimum amount of harm was caused [13].However, further studies are needed to explore this topic, as regulations are enforced to assure client safety and quality of care [8], and noncompliance may result in reduced quality of care and even potential harm for clients.Especially, as older people in need of care may not have sufcient capabilities to report misconduct, staf themselves are often required to report misconduct [35], and as the severity of the consequences of noncompliance may vary [13], the extent and efects of regulation noncompliance within care services for older people require further investigation.
Lower team autonomy increased the odds of regulation noncompliance in both service housing facilities and home care services.Previous study on team autonomy in care services has found that team autonomy is associated with higher staf satisfaction [36,37] implying that supporting team autonomy may both enhance work satisfaction and facilitate opportunities to regulatory compliance.Disturbances were also signifcantly associated with regulation noncompliance in both contexts, indicating that better planning for unexpected events may increase regulatory compliance.Although disturbances were not further defned in this study, the mean number of disturbances was one in both home care services and service housing, indicating disturbances to be somewhat commonplace.Terefore, further study should explore what type of disturbances takes place and explore if disturbances could be reduced with better management or increased stafng.
Te results of this study indicate that it is possible that staf members may perceive and/or experience the regulations of the organization as unattainable and therefore feel a need to prioritize tasks.A previous study found that the way in which nurses' aides organize their work was Health & Social Care in the Community  Health & Social Care in the Community a determinant of both quality of care and staf turnover; those staf members that did not adapt their work according to the working conditions, risked repercussions for the patients and other staf members, such as patients being unattended or partially assisted, and staf members that did not, or could not, increase their efciency or felt the care provided was unacceptable were more likely to resign [13].It should therefore be noted that prioritization may result in varying levels of experienced distress upon noncompliance.For instance, if prioritization is done for the good of the clients, it is possible that this action may to some level alleviate moral distress, rather than contribute to it.It should also be noted that within this study, regulations were not further defned, and therefore, these results represent the participants' subjective understandings.It is possible that the severity of noncompliance difers and may therefore result in varying consequences for the clients.It is therefore paramount to further explore the consequences of regulation noncompliance to clients, especially as previous studies have indicated unmet needs among older people receiving care services [17,18] and less favorable working environments being associated with rushed or missed care tasks [38].Tese results raise questions as to how to ensure quality of care, of which regulatory compliance is a pivotal part, as resources for care of older people have reduced [39,40].While regulation noncompliance behaviors of staf may both compromise the quality of care and be a signifcant work stressor, both being factors that require further study, the results of this exploratory study revealed organizational factors, which may be addressed to promote regulatory compliance within care services for older people.
Te results of this study imply that increasing resources and time to attend to tasks and clients may increase possibilities to regulatory compliance, ultimately improving the quality of care.It may also be benefcial to support team autonomy and planning for unexpected events.Team autonomy may also increase efciency in two ways: if the teams have reasonable number of clients, the employees get to know clients and their needs and habits, which makes the work easier and efective.Secondly, when teams are able to plan their work more autonomously, they can better adapt their visits to the needs of clients.It seems more resources need to be allocated from the policy level to the organizational level, to ensure adequate stafng and time for staf to perform tasks.It also seems staf may not be able to provide care that is perceived as sufcient with current resources, which may infuence levels of experienced stress.Furthermore, qualitative and quantitative studies on regulation noncompliance are needed to better understand the multifaceted reasons behind, and consequences of, regulation noncompliance in care services.Specifcally, future research should explore in which situations staf engage in regulation noncompliance behaviors, and how regulatory noncompliance is associated with quality of care, experienced moral distress, stress, and work satisfaction among care staf.Furthermore, the relationship between team autonomy and regulatory compliance warrants further investigation.Te results of this study may be utilized to inform stakeholders of the factors currently infuencing regulatory compliance and assist in planning interventions.Interventions to reduce regulation noncompliance may not only contribute to increased quality of care, but also assist in ensuring staf retention and satisfaction.

Limitations.
As the study data were collected as self-report surveys, it is possible that the subjective nature of the data may infuence the results and that the actual amount of care time provided varies from that reported here.As the study was voluntary for organizations, the units that decided to participate in the study may be those with overall better resources.Te facilities with lower quality of care or more negative work environments may have not participated in the study.Tus, we cannot fully say that the study represents the Finnish services for older people.Tese results may therefore be mainly representative of organizations with better stafng situations and/or with management supportive of development and research.Te subjective nature of the question relating to regulation noncompliance may also infuence the results, as no exact defnition for regulatory noncompliance was provided.As in all self-report surveys, this may result in varying responses [41], and no direct conclusions can be drawn as to the severity or consequences of the exhibited noncompliance, as the nature of the transgressions may vary.It is also possible that in self-reports, employees answer what is expected to be suitable.On the other hand, the anonymous answering may relieve this tendency.Finally, as regulation noncompliance may be viewed as a controversial action, it is possible that the responses refect socially desirable answers [42].Tis may have resulted in an underestimate of the number of staf that violated regulations.However, this exploratory study ofers insight into a topic that has been scarcely researched, providing current and important knowledge on regulation noncompliance within care services for older people.

Conclusion
Te results of this study imply that regulation noncompliance in service housing facilities may be due to staf cutting corners or prioritizing to be able to provide care that is perceived as sufcient.In home care services, staf may need to violate against regulations, especially when attending to clients with higher care needs, due to a lack of time or resources.Supporting team autonomy, as well as ensuring adequate stafng and time to attend to tasks, may help ensure regulatory compliance.

Table 1 :
Overview of variables utilized in this study.Care time in relation to the clinical complexity of clients was measured by subtracting the amount of care time reported in the staf time measurement from the clients' CMI group.Tis resulted in a variable indicating if the clients' care time was above or below the mean for the clients' CMI group, indicating if the staf were able to provide above or below the mean care time in relation to the clients' clinical complexity.
[29]ious study has indicated that the CMI often is between 1 and 2[30].Each clinical diagnostic group also has its own baseline value, indicating the resources the clients require in relation to the mean within the clinical diagnostic group.Terefore, each diagnostic group indicates the resources the clients require in relation to all the clients, as well as in relation to others within the same diagnostic group[29].For this study, separate context-specifc weights have been calculated for both home care services and service housing facilities, with data derived from RAI assessments used to calculate diagnostic groups.Te diagnostic groups were defned using the Finnish Resource Utilization Group (RUG-III/18) classifcation system.Te mean CMI of the clients the staf member attended to was calculated for each staf member.3.8.Care Time in Relation to the Clinical Complexity of Clients.

Table 2 :
Characteristics of the sample.

Table 3 :
Results of logistic regression models-variables explaining regulation noncompliance in service housing facilities.

Table 4 :
Results of logistic regression models-variables explaining regulation noncompliance in home care services.