Substantive Accountability and Trust in Nursing Home Services in a Comparative Perspective (TrustInCare). Accountability and trust in the provision of nursing home services are crucial for their sustainability and well-functioning. Previous studies have investigated the effect of transparency as a way to increase trustworthiness in governments, in regulatory agencies, and policies. Although previous studies have provided important insights about the effect of transparency on the levels of trust at the organizational level, the analysis of accountability of core social policies has received scarce attention. Which model of service provision is more accountable? Which model do beneficiaries prefer, and how would the adoption of specific mechanisms for their accountability and regulation affect trust in the services?

TrustInCare examines the perceptions and attitudes of potential service beneficiaries on the accountability and trust in nursing home services across European countries. TrustInCare investigates the variables that affect the perceptions of accountability and trust in nursing home services, such as the type of provider (public, private for-profit and nonprofit facilities) and the inequality of the users/beneficiaries. We also investigate the effect that different arrangements of regulation models/tools of the services have on the trust by their beneficiaries.

To answer these questions, we will conduct a survey and a conjoint survey experiment in countries that have different welfare regimens, specifically, Denmark and the Netherlands/UK. These surveys will complement the study conducted in Spain (CARE- Spain), which will allow us to compare perceptions and attitudes on accountability and trust in nursing home services across welfare regimes.

From this research we will be able to investigate substantive accountability of the structures, processes and outcomes of nursing home services across European countries from a comparative perspective. We will assess how beneficiaries perceive the competence of service providers, the fairness in treatment of all users, and the alignment of service providers’ interests with the welfare of residents. Additionally, we will investigate how different regulatory and accountability arrangements may impact the levels of trust in these services. We will test the idea that different arrangements of regulation and accountability could affect –to a greater or lesser extent– the levels of trust in the services. Given that the Covid-19 crisis has exposed shortcomings in the governance model within this sector, particularly as it predominantly impacts the elderly residing in these facilities, we further explore perceptions of accountability in crisis management. Specifically, we aim to investigate responses by examining the perceptions beneficiaries hold regarding the actions taken by nursing home facilities and other key stakeholders on the demand side of accountability, such as governments.