Building Quality Governance for Long-Term Care in Viet Nam: Accountability, Safety and Continuous Improvement as Services Expand
LONG-TERM CARE QUALITYMEASUREMENT, IMPLEMENTATION & LEARNING
Building Quality Governance for Long-Term Care in Viet Nam: Accountability, Safety and Continuous Improvement as Services Expand
LONG-TERM CARE QUALITY & GOVERNANCE
Last reviewed: October 2026
Long-term care in Viet Nam is entering an important period of development. As the population ages, more older people will need sustained support with daily activities, mobility, cognition, nutrition, medicines, rehabilitation, chronic conditions or personal care. Families will continue to play a major role, but demand is also likely to grow for formal home-care services, community-based programs, day-care models, social assistance establishments, rehabilitation services and residential care.
Expanding these options is necessary, but increasing the number of services is not enough. The more important question is whether Viet Nam can expand long-term care while making sure that older people receive care that is safe, respectful, coordinated and consistently improved over time. That requires quality governance: clear accountability, appropriate standards, competent staff, risk controls, measurement, oversight, learning and continuous improvement working together as a system. Viet Nam has an opportunity to build this quality infrastructure while long-term care is still developing, rather than trying to add it after services have already expanded unevenly.
Long-term care is broader than residential care
Long-term care is sometimes understood mainly as care provided in a nursing home or residential facility. Internationally, the concept is much broader. WHO's approach encompasses care and support that help people experiencing significant and sustained declines in capacity maintain functional ability, exercise their rights and live with dignity. Depending on individual needs and national context, this may include assistance with daily activities, social care, support for health conditions, rehabilitation and palliative needs, delivered at home, in the community or in residential settings.
This distinction matters for quality governance. If quality requirements are designed only around buildings and institutional facilities, a growing part of long-term care may remain outside the quality lens. An older person receiving help with medicines, bathing, mobility, nutrition or dementia-related needs at home may face many of the same underlying risks as someone receiving formal residential care, even though the setting and responsible organizations are different. The location of care changes; the need for appropriate accountability, competence and safety does not.
Viet Nam has important foundations, but not yet one integrated long-term care quality system
Viet Nam is not starting from zero. The Law on Older Persons, reflected in Consolidated Document No. 23/VBHN-VPQH dated 26 February 2026, establishes important rights and responsibilities relating to the protection and care of older people. It provides a legal basis for care establishments serving older people and for the responsibilities of the State, families and society in supporting older people.
Existing rules for social assistance establishments also contain important quality-related elements. Circular No. 33/2017/TT-BLĐTBXH, which remains partly in force, addresses organizational arrangements, staffing norms, social-assistance processes and service standards for establishments within its scope. It includes processes for assessment, care planning, implementation, monitoring and adjustment and differentiates some staffing requirements according to care needs. Parts of the Circular were subsequently superseded by Circular No. 02/2020/TT-BLĐTBXH, so it should not be read as an unchanged or universal standard for every emerging form of long-term care. Administrative responsibilities in the social-protection field have also been reallocated in parts of the system under Viet Nam's two-tier local government arrangements, including through Decree No. 147/2025/NĐ-CP and Circular No. 14/2025/TT-BYT.
These instruments matter, but long-term care increasingly crosses boundaries between social assistance, healthcare, rehabilitation, home care, community support and privately purchased services. The legal requirements applying to a provider therefore depend on what the organization actually does, its legal form, the services it provides and whether regulated healthcare activities are involved. The existence of multiple relevant rules should not be confused with the existence of a single, setting-spanning national system for long-term care quality governance.
The National Strategy on Older Persons to 2035, with a vision to 2045, approved by Decision No. 383/QĐ-TTg on 21 February 2025, moves Viet Nam further in this direction. It calls for developing and improving the quality of social-care services for older people, mobilizing private-sector participation, strengthening care and rehabilitation facilities, developing care models and establishing standards and service processes to improve quality.
Important health and community-care building blocks followed in 2026. Decision No. 1116/QĐ-TTg of 22 June 2026 amended the national Older People Health Care Program to 2030. Decision No. 1976/QĐ-BYT of 1 July 2026 issued professional guidance for caring for older people at home and in the community. Among other elements, the guidance incorporates the ICOPE approach, including initial screening across six domains of intrinsic capacity, identification of care and social-support needs and development of care plans. Circular No. 34/2026/TT-BYT subsequently guides selected activities under the National Target Program on Health, Population and Development and explicitly references Decision No. 1976/QĐ-BYT for training and community-based older-person care activities.
Taken together, these developments provide meaningful foundations. But they do not yet amount to one national long-term care quality-governance framework covering home, community and facility-based services through common expectations for accountability, safeguarding, safety, measurement, workforce competence and continuous improvement. That remains an important area for development.
The policy direction is becoming clearer
The direction became clearer during 2026. Decision No. 1702/QĐ-TTg of 3 September 2026, approving the Project on Strengthening International Cooperation on Older People for 2026–2031, identifies healthy aging, long-term care, old-age social security and support for caregivers as priority areas for international cooperation. The Project sets a goal of promoting at least five international programs, projects or cooperation models capable of being piloted, evaluated and potentially scaled in areas that include health, long-term care and community-based care. This is not a long-term care regulatory framework, but it is another indication that long-term care is becoming a more explicit part of Viet Nam's policy agenda.
The direction became more explicit again at the national conference reviewing implementation of the Law on Older Persons on 30 September 2026. The Ministry of Health proposed three major policy groups for revision of the Law. One proposal is to develop a comprehensive long-term care system that prioritizes care within families and communities, diversifies services, standardizes the quality of care establishments and strengthens workforce capacity. Another proposal includes studying long-term care insurance as part of the broader social-protection agenda.
The distinction between policy development and enacted law is important. As of October 2026, these remain proposals informing the revision process, not statutory requirements already imposed on long-term care providers. Nevertheless, they raise a timely question that Viet Nam can begin addressing now: if long-term care services are going to expand, what quality-governance system should develop alongside them?
Quality governance begins by making accountability visible
Many failures in complex care do not occur because nobody cares. They occur because responsibility is fragmented or unclear.
Consider an older person returning home after a hospital admission. A daughter organizes medicines. A paid caregiver assists with bathing and meals. A rehabilitation professional visits twice a week. The older person also attends a hospital clinic and may receive support from local health services. Who notices if appetite is declining? Who knows that a medicine was discontinued during the hospital admission? Who is responsible for escalating a new pressure injury? Who determines whether the caregiver is competent to perform a particular task? Who checks whether rehabilitation goals remain appropriate? Who receives a complaint, and who reviews a fall?
When several people are involved but nobody clearly owns coordination, risk can remain invisible until something serious happens. Quality governance therefore begins with explicit accountability. A formal long-term care provider should be able to describe its service scope, what it takes responsibility for, which activities staff may and may not perform, how health concerns are referred or escalated, who is responsible for quality and safety, and what happens to responsibility when a person moves between providers or settings.
This becomes particularly important where social care and healthcare overlap. Helping someone eat is not automatically a medical intervention, but feeding a person with significant swallowing difficulty can involve substantial clinical risk. Reminding someone to take a prescribed medicine is different from making a medication decision. Supporting mobility is different from independently evaluating a new neurological change. Good governance makes those boundaries clear before an incident exposes them.
Long-term care has a distinctive safety profile
Older people receiving long-term care may experience frailty, cognitive impairment, mobility limitation, sensory loss, multimorbidity, polypharmacy or dependence on others for essential daily activities. These characteristics can increase vulnerability to harm even when care appears routine. Depending on the population and care setting, important risks may include falls, medication-related harm, pressure injuries, malnutrition, dehydration, infection, aspiration or choking, delayed recognition of deterioration, unsafe transfers, functional decline, inappropriate restraint, neglect and abuse.
Not every home-care service or residential facility needs identical controls. A community activity program serving relatively independent older adults should not be governed as though it were a high-dependency residential service caring for people with advanced dementia and complex health needs. Quality governance should therefore be proportionate to risk: as dependency, complexity and the potential consequences of failure increase, stronger expectations are needed for assessment, care planning, competency, supervision, emergency response, documentation, escalation and review.
This principle is important for future regulation as well. Over-regulating low-risk support can restrict access and innovation, while under-regulating high-risk care can expose vulnerable people to preventable harm. The objective should be proportionality rather than treating every service labeled “older-person care” as though it were the same.
Workforce capability is part of the safety system
Long-term care depends heavily on people, which means workforce quality cannot be treated simply as a human-resources issue. A service may meet a numerical staffing requirement and still be unsafe if workers are not trained for the tasks they perform, cannot recognize deterioration, lack appropriate supervision or are routinely expected to work beyond their competence.
Staffing ratios can be useful, but numbers alone do not describe care needs. Ten older people who remain largely independent create a very different workload from ten people who require extensive assistance with mobility, feeding, cognition, continence and personal care. Existing Vietnamese standards already recognize some of this difference within social assistance establishments. Circular No. 33/2017/TT-BLĐTBXH, for example, differentiates certain staffing norms according to whether older people can care for themselves. These requirements are important within their legal scope, but they should not be treated as universal staffing standards for every form of long-term care in Viet Nam.
A stronger quality approach combines staffing numbers with competency, care dependency, workload, supervision and continuity. Providers need to know not only how many staff are present, but whether the people available at a particular time can safely meet the needs of the people they support.
Rights, dignity and safeguarding belong inside quality governance
Good long-term care is not defined only by the absence of clinical harm. An older person can be physically safe and still receive poor care if they are routinely ignored, infantilized, isolated, unnecessarily restricted, denied meaningful choice or excluded from decisions about their own life.
Viet Nam's legal framework already recognizes important rights of older people, and recent national policy discussions are placing greater emphasis on rights, dignity, autonomy, participation and independent living. At the September 2026 conference reviewing the Law on Older Persons, the Ministry of Health called for a shift in approach from assistance toward ensuring rights and supporting older people to live healthier, more independent and higher-quality lives. United Nations representatives at the same conference also advocated a rights-based approach centered on dignity, choice, participation and inclusion. These are important policy signals, but they should not be described as new legal rights already enacted through the proposed amendments.
Rights require operational mechanisms. Long-term care organizations need ways to identify and respond to physical, psychological, sexual and financial abuse, neglect, exploitation, inappropriate restrictions and other safeguarding concerns. Staff need to know how and where to report concerns, including concerns involving colleagues, managers or family members. Older people and their families need accessible ways to raise concerns without fear that speaking up will reduce the quality of care they receive.
Safeguarding should therefore be embedded in quality governance rather than treated as an exceptional issue considered only after a serious case reaches authorities.
Quality should be measured through outcomes and experience, not compliance alone
A long-term care provider can have appropriate documents, maintain a clean environment and pass an inspection while still delivering inconsistent care. Compliance is necessary, but compliance alone does not tell us whether people are actually experiencing good care.
A stronger measurement system asks what happens to the people receiving services. Are falls occurring, and are recurrent falls being reduced? Are pressure injuries developing during care? Are medicines reconciled following hospital transitions? Is nutritional risk recognized? Are people losing function unnecessarily? Are unplanned hospital transfers occurring repeatedly? Are care plans reviewed when someone's condition, function or preferences change?
Quality also includes experience. Do older people feel respected? Are their priorities known? Can they participate meaningfully in decisions? Do they understand their care? Do they feel safe? Are they able to maintain relationships and activities that matter to them?
Families and unpaid caregivers provide another important perspective. Are they adequately informed? Do they understand what they are expected to do? Are they being asked to undertake complex responsibilities without adequate preparation, training or support?
The WHO Regional Office for Europe has developed a useful quality-management framework that brings together quality standards, measurement, quality assurance and monitoring, and systematic quality improvement, with outcomes that matter to care users and caregivers at its center. Although developed in a European policy context, these principles provide useful reference points for countries developing or redesigning long-term care quality systems.
Viet Nam does not need hundreds of indicators to begin. A relatively small, balanced set covering safety, function, care experience, coordination, workforce and serious incidents may be more useful than a large reporting system in which data are collected but rarely used to improve care.
Incident reporting should lead to learning, not just paperwork
Falls will still occur. Medication errors will still occur. Hospital transfers will still happen, and some deterioration will be unavoidable because long-term care supports people with substantial underlying vulnerability. The purpose of quality governance is not to create the fiction that every adverse outcome is preventable. It is to make preventable harm less likely and ensure that important events generate learning.
A fall, for example, should lead to more than completion of an incident form. Was the person recently prescribed a medicine associated with dizziness? Had mobility changed? Was an appropriate walking aid available? Was lighting adequate? Were continence needs contributing to nighttime mobility? Had the person fallen before? Did staffing, supervision or the environment contribute? Was the care plan changed afterward?
If three similar falls occur and each event is documented separately without anyone identifying the pattern, the organization has incident reporting but not organizational learning. Quality governance connects individual events to trends, contributing factors, corrective actions and measurable improvement.
Home and community care cannot become a quality blind spot
Viet Nam is placing greater emphasis on care at home and in the community. Decision No. 1976/QĐ-BYT provides detailed professional guidance for these settings, including daily care, health counseling, screening for six domains of intrinsic capacity, identification of care needs and development of care plans using the ICOPE approach. Circular No. 34/2026/TT-BYT connects elements of this guidance to community implementation and workforce training under the National Target Program.
This direction is important because home- and community-based services can help older people remain in familiar surroundings and maintain connections with family and community. But care delivered inside a private home is also less visible than care provided inside an institution. A facility has managers, colleagues, records and infrastructure that can be inspected. A home-care worker may spend long periods alone with an older person. An unpaid family caregiver may be exhausted and inadequately supported. Several different workers may visit without reliably sharing information with one another.
This does not mean home care is inherently less safe. It means the quality risks are different. The WHO Regional Office for Europe highlighted this challenge in 2025, noting a growing gap between the rapid expansion of home- and community-based long-term care and the slower development of regulatory structures for quality management. Its technical work emphasizes standards, indicators, assurance mechanisms and continuous improvement rather than assuming that community-based care will automatically be high quality simply because it takes place outside an institution.
Viet Nam has an opportunity to avoid the same gap by building proportionate quality expectations into home- and community-based service development from the beginning.
Care transitions should be governed as part of long-term care quality
A substantial amount of risk occurs not within one service but between services. An older person may leave hospital with new medicines, reduced mobility, a wound requiring care, changed nutritional needs and several follow-up appointments. The hospital may consider the discharge completed while the family is only beginning to understand what has changed.
If the person returns to a residential or community-care provider, the same questions arise. Has the medication list been reconciled? Are changes in mobility and function understood? Have nutritional or infection-control needs changed? Does the receiving provider know which warning signs require escalation? Are follow-up appointments arranged? Does the family know whom to contact if the person's condition deteriorates?
A technically successful discharge can therefore become an unsafe care transition. Quality governance should make information transfer, reconciliation, escalation and continuity explicit responsibilities rather than assuming that essential information will naturally follow the person from one setting to another.
This is particularly important in Viet Nam because future long-term care is unlikely to develop as one self-contained sector. Older people will move repeatedly between hospitals, primary and community care, rehabilitation, family care and increasingly diverse formal support services. Quality will depend partly on how well those boundaries are managed.
Continuous improvement changes the question from “Are we compliant?” to “Are we getting better?”
Traditional regulation often asks whether a provider met a required standard on the day of inspection. That is necessary, especially for minimum safety protections, but long-term care quality cannot be created through periodic inspection alone.
Continuous improvement asks different questions. Which problems are recurring? Which residents experience repeated falls? Why are hospital transfers concentrated in a particular group? Why are care plans not being reviewed after changes in condition? Why are complaints repeatedly about communication? Has training changed actual practice, or did staff simply attend a course?
A provider might identify frequent falls during nighttime bathroom visits. Instead of responding only with another staff reminder, it could examine medicines, mobility, continence, lighting, footwear, walking aids, staffing patterns and individual assessments; introduce targeted changes; measure whether falls decline; and revise the approach again if improvement does not occur.
That cycle—identify, understand, intervene, measure, learn and improve—is what turns quality from a policy document into an operating system.
A practical minimum quality-governance architecture is possible
Viet Nam does not need to wait until every future component of its long-term care system has been legislated before providers begin strengthening quality governance. A practical organizational framework can already be built around several connected functions.
The first is accountability: a clearly defined scope of service, governance responsibilities and ownership of quality and safety. The second is person-centered assessment and care planning, so care reflects function, preferences, risks, health needs and social circumstances rather than simply delivering a standardized package.
The third is workforce governance: appropriate staffing, competency assessment, supervision and clear boundaries around what different workers can safely do. The fourth is safety and safeguarding, including priority care risks, emergency response, abuse and neglect, escalation and protection of dignity and autonomy.
The fifth is coordination and transitions, including referral pathways, communication with healthcare providers and reliable transfer of essential information. The sixth is measurement and learning, using a manageable set of indicators together with incidents, complaints, care experience and outcomes to understand performance. The seventh is continuous improvement: a structured process for converting those findings into changes and then checking whether those changes actually make care better.
None of these functions is unusual on its own. Their value comes from connecting them so that assessment influences care planning, incidents influence improvement, complaints influence governance, staffing reflects actual care needs and leaders can see whether quality is improving or deteriorating.
National quality governance will eventually need to connect several levels
Provider-level improvement cannot replace system-level governance. As Viet Nam's long-term care sector matures, national and local governance will likely need progressively clearer definitions of service models and permitted activities; proportionate registration, licensing or authorization arrangements; minimum expectations for safety and safeguarding; workforce competency frameworks; mechanisms for complaints and serious incidents; and a core approach to quality measurement.
Financing will matter as well. Payment systems can reward activity or occupancy without necessarily rewarding good outcomes. If future public financing, contracting or long-term care insurance develops, quality expectations should ideally be built into purchasing and contracting arrangements rather than added afterward.
Transparency also requires careful design. Public reporting can strengthen accountability and help families make informed choices, but simplistic rankings may distort behavior or unfairly penalize providers caring for people with greater dependency and complexity. Indicators therefore need appropriate definitions, interpretation and context.
Inspection and external oversight remain important, but their purpose should extend beyond identifying noncompliance. Effective governance can also help organizations improve by clarifying expectations, identifying systemic risks, supporting learning and spreading effective practices.
WHO's emerging global standards create a timely opportunity for Viet Nam
Internationally, long-term care quality governance is also evolving. On 18 May 2026, WHO released the draft Global Standards for Long-Term Care for public consultation, describing it as the first global standards framework intended to guide the planning, delivery, monitoring and improvement of long-term care for older people. The consultation draft contains 34 standards and 106 quality statements organized across eight chapters covering definitions and principles, home- and community-based care, facility-based care, support for unpaid carers, workforce, financing, governance and quality monitoring.
As of October 2026, these standards are not final. WHO's consultation remains open until 30 October 2026, after which feedback will inform revision before finalization and official publication. They should therefore not be presented as finalized WHO standards or as regulatory requirements applying in Viet Nam. The working draft is explicitly identified as a consultation draft and not a final normative publication.
The direction, however, is highly relevant. Governance and quality monitoring are being treated as core components of the emerging global framework, reinforcing a fundamental point: long-term care quality is not created only during an individual care interaction. It depends on the system surrounding that interaction.
WHO is also separately developing Global Standards for Quality Health Care Services for Older People. A multidisciplinary Technical Working Group involving members from 24 countries was convened in 2026 to support the development of standards, indicators and implementation guidance for person-centered, integrated and responsive healthcare for older people. WHO has explicitly described this work as complementary to the Global Standards for Long-Term Care: the long-term care standards address the structure and quality of long-term care systems, while the healthcare standards focus more specifically on the effectiveness, safety and person-centeredness of healthcare delivery for older people, particularly within a primary healthcare approach.
For Viet Nam, these international developments provide useful reference points rather than templates to copy directly. Viet Nam's combination of family caregiving, community resources, social assistance, healthcare services, public provision and emerging private care models requires a quality framework that is locally workable and proportionate to different types of service and risk.
Expansion and quality should be designed together
Long-term care in Viet Nam is likely to become more diverse. Demand will grow for combinations of home care, community support, rehabilitation, dementia care, day services, residential care, technology-enabled support and caregiver assistance. That diversity can be positive if it gives older people and families more options that fit their needs and preferences.
The risk arises when service development moves faster than the mechanisms that make quality visible and accountable. A rapidly expanding market without adequate quality governance can create wide variation between providers. A highly restrictive system, by contrast, can limit access and innovation without necessarily improving outcomes. The objective should therefore not be maximum regulation. It should be intelligent, proportionate governance: clear minimum protections, meaningful accountability, competent care, appropriate oversight, useful measurement and a culture of learning and improvement.
Viet Nam's current policy trajectory creates a valuable opportunity to build these principles into the next stage of long-term care development. The National Strategy on Older Persons already calls for stronger services and improved quality. New guidance is giving greater structure to care at home and in the community. Long-term care has become an explicit priority for international cooperation. The Ministry of Health is now proposing a comprehensive long-term care system as part of future revision of the Law on Older Persons, including quality standardization and stronger workforce capacity. At the same time, WHO is developing the first global standards framework specifically for long-term care.
The next question for Viet Nam should therefore not simply be: How many long-term care services can we develop? A more important question is: As these services expand, how will we know that older people are consistently receiving care that is safe, respectful, coordinated and improving over time?
When accountability, safeguarding, workforce capability, measurement, learning and continuous improvement become part of the infrastructure of long-term care rather than optional features of individual providers, expansion becomes more than an increase in service capacity. It becomes the development of a care system that older people and families can trust.
References
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