One of the huge problems in health and long-term care services is that typically decisions get made regarding services, the organization of services, the timing of services, who delivers the service by persons occupying positions of authority.  Decisions at a high regulatory level are made by government officials who may or may not, usually not, have had training and experience in the area of concern by the regulation.  This phenomenon is not uncommon in governmental regulatory agencies.

At a clinical or direct service level, decisions get made by staff who are engaged, as is the case in nursing homes, to provide direction for administration, care, activity and such.  Decisions are influenced by government regulations, national and provincial best-practices, and collaboration between service providers including physicians.  Often equipment suppliers play a role as they introduce the best of technology at “trade shows” and communicate new technology to service providers.