Challenges to the operation of brazilian LTCIs and changes in oversight

Abstract Background Despite 18 years since health surveillance regulations were promulgated in Brazil to govern Long-Term Care Institutions for the Elderly (LTCIs), many institutions fail to comply with the Differentiated Regime for Public Procurement (Resolution No. 502/2021) due to structural and operational conditions. This study aimed to investigate Brazilian LTCI managers' understanding of challenges that significantly impact institutional operation and gather suggestions for enhancing RDC No. 502/21. Methods A cross-sectional, exploratory, and qualitative study was conducted, involving 90 managers or technical supervisors from Brazilian LTCIs. Data were collected using a self-administered Google Forms instrument and analyzed through Thematic Analysis based on the Organizing for Quality (OQ) framework. Results The most impactful challenges for LTCIs were healthcare, financing, human resources, relationship with oversight bodies, and family members. Proposed improvements for RDC No. 502/21 included enhanced professional training, infrastructure revision, increased financial support from the state, realistic oversight/regulations, and tailored monitoring approaches. Conclusions LTCIs in Brazil face numerous challenges, and the suggested improvements aim to adapt regulations to institutional realities. However, considering the regulations' variability and purposes, further investigation is warranted.