From abstract goals to concrete rules: Regulating nursing home care in Sweden and the Netherlands

To legislate complex topics, both the Dutch and Swedish legislature use goal legislation. Goal acts contain abstract goals which the regulatee should reach instead of detailed prescriptions of how the regulatee should act. Goal acts combine these abstract goal rules with an assignment to other actors to ‘concretize’ these abstract goals into more detailed rules: they shift further regulation away from the traditional legislature, which gives the regulatee more freedom. But if the legislature does not concretize the main goal of the act, then who decides what the act entails in practice? Two case studies of regulation of quality of nursing home care in the Netherlands and Sweden show that many decisions on the content of goal acts are taken by the regulatee itself. Important decisions on what ‘good’ or ‘responsible care’ is, are taken in the care planning meeting between the care staff and the resident of a nursing home or in the nursing home’s internal protocols of the quality management system. The case studies also show that this freedom of the regulatee should be balanced with control on a national level. To protect the interests of vulnerable third parties, such as the residents of nursing homes, one needs effective supervision on the abstract goals which also takes into account these interests. The legislature should be aware of this dilemma between freedom of the regulatee and the need of national control when drafting goal legislation and should take appropriate measures to obtain this balance.