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Accréditation Sans Frontières

International Accreditation of Healthcare Facilities

ASF Standards · Long-Term Care · Standard 3

Standard 3 — Personal Care & Daily Living

5 criteria · 3 non-negotiable · 2 core · Version 3.0

Criteria in this standard

3.1

Activities of Daily Living Support Prevents Unnecessary Decline

Non-Negotiable

A resident's ability to perform activities of daily living — hygiene, mobility, eating, toileting — is actively supported to prevent avoidable decline, with any diminution genuinely tied to an unavoidable clinical cause, documented specifically, not assumed as a normal part of aging or long-term residence.

In plain terms: Residents are helped to keep doing what they can — walking, washing, eating, toileting — rather than having it done for them because it is faster. Decline that is not medically necessary is prevented.

Facility category Crisis Transition Small Standard
Applicability Adapted Full Full Full

Why this matters

A resident who can walk to the dining room but is wheeled because it is quicker will stop being able to walk within weeks. A resident who can feed herself slowly but is fed because the tray must be cleared will lose the ability. Deconditioning is the most preventable harm in long-term care and the most common. Every task done for a resident who could do it themselves takes something away. Restorative care means: assess what the resident can do, support them to keep doing it (time, equipment, encouragement), and measure function over time so decline is detected and addressed — not accepted as inevitable.

What good looks like

  • ADL support genuinely maintains resident capability, not just completes tasks.
  • Any decline is tied to a specific, documented, unavoidable clinical cause.
  • Care plans are genuinely reviewed and adjusted as ability changes.

Common failure modes

  • Staff routinely complete ADL tasks for residents who could do them with support.
  • Decline is assumed as normal aging without specific clinical justification.
  • Care plans remain static despite genuine changes in resident ability.

Worked example

In practice
A 60-bed care home where task completion was prioritised over resident independence.
BeforeCare assistants completed morning care as fast as possible: washing, dressing, and transferring residents rather than supporting them to do it. Residents who walked in were in wheelchairs within months. Functional status was not measured. Staff said 'there isn't time to let them do it themselves.'
ActionA restorative care approach was adopted: every resident's functional abilities (Barthel or equivalent) are assessed at admission and monthly; the care plan states what the resident does themselves and what support they need; care assistants are trained to 'do with, not for'; time is allocated accordingly; a mobility programme ensures every ambulant resident walks daily. Monthly function scores are reviewed; any decline triggers review.
AfterThe Monitor reviewed 20 care plans with functional goals, six months of monthly function scores (decline halved), and observed care assistants supporting rather than doing. Verified.

If you are starting from zero — do this first

  1. Watch morning care for three residents. How much do they do themselves?
  2. Assess every resident's function with a standard tool.
  3. Write in each plan what they do themselves.
  4. Measure function monthly and act on decline.
The most common mistake: Doing it for the resident because it is faster — you are trading five minutes today for their independence forever.

Self-assessment questions

1. Is ADL support genuinely aimed at maintaining the resident's own ability, not simply completing the task for them? — Support that maintains capability, not task completion that bypasses it.
Evidence: ADL care plan and approach documentation
2. When ADL decline occurs, is it specifically tied to a documented, unavoidable clinical cause? — A specific, documented clinical reason, not an assumption that decline is simply expected.
Evidence: Decline documentation and clinical justification
3. Are care plans reviewed and adjusted as a resident's ADL ability changes, in either direction? — Genuine, ongoing adjustment, not a static plan set once and left unchanged.
Evidence: ADL care plan review record

Common reasons for a PARTIAL answer

  • Ability-maintaining support happens during less busy periods but tasks are completed directly when time is short. — Genuine support needs to hold up under real time pressure, not only when convenient.
  • Decline is documented but the specific clinical cause isn't always clearly identified. — A vague justification is difficult to distinguish from decline that was actually preventable.
  • Care plans are reviewed on schedule but don't consistently reflect genuine changes in resident ability.

Implementation plan

When What
Week 1 Observe current ADL support practice for genuine ability-maintaining approach.
Week 2 Train staff specifically on supporting rather than replacing resident capability.
Week 3 Establish specific clinical documentation requirements for any ADL decline.
Ongoing Review and adjust ADL care plans as resident ability genuinely changes.

How the Monitor verifies this

Method What Detail
OBSERVE ADL support practice observation Observes actual ADL assistance for genuine ability-maintaining support versus task completion.
DOCUMENT Decline documentation review Reviews documented ADL decline for specific, genuine clinical justification.
DOCUMENT Care plan review record check Reviews whether ADL care plans are genuinely reviewed and adjusted as ability changes.

Supervisor tips

  • Observe an actual ADL assistance interaction, particularly during a busy period. — This is where the real difference between support and task completion is most visible.
  • Ask for a specific example of documented decline and its clinical justification. — A real, specific example reveals whether justification is genuine, not just assumed.

Evidence base

[11] Established long-term care regulatory principles, recognized in various forms across many countries' care standards, require the facility to provide necessary care and services to ensure a resident's abilities in activities of daily living do not diminish unless the individual's clinical condition demonstrates the diminution was unavoidable.

ASF training courses on GMJ Academy →

Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.

3.2

Nutrition and Hydration Are Individualized and Actively Monitored

Non-Negotiable

Every resident receives a nourishing diet meeting their individual nutritional and special dietary needs, with hydration and eating assistance actively provided as needed — not a standardized menu applied uniformly regardless of individual requirements.

In plain terms: Every resident's diet and fluids match their individual needs — therapeutic diet, texture, preferences, cultural requirements — and eating and drinking are watched and recorded so problems are caught.

Facility category Crisis Transition Small Standard
Applicability Adapted Full Full Full

Why this matters

Malnutrition and dehydration are endemic in care homes and are causes, not consequences, of decline. The resident with dysphagia who gets regular texture chokes. The diabetic who gets the same pudding as everyone else has unstable glucose. The resident who dislikes the food eats nothing and nobody notices. The resident who cannot lift the cup does not drink. Individualised means: a nutrition and hydration assessment; a diet that matches needs and preferences; food and fluid intake monitored — not 'ate well' but what and how much; and action when intake drops. The dietitian, the kitchen, and the care staff must be connected.

What good looks like

  • Every resident's diet genuinely reflects their individual needs.
  • Eating and drinking assistance is actively provided to residents who need it.
  • A qualified dietitian is genuinely involved in individual nutrition planning.

Common failure modes

  • A standardized menu is applied regardless of individual dietary needs.
  • Residents needing assistance are left to manage eating or drinking alone.
  • Nutrition plans lack genuine professional dietitian involvement.

Worked example

In practice
A 50-bed care home with a single menu and no intake monitoring.
BeforeAll residents received the same meals with texture modification for those on a list. Intake was recorded as 'good/fair/poor' by impression. Three residents had lost significant weight in three months; nobody had connected it to intake. Fluid intake was not recorded. Two residents had been admitted to hospital with dehydration.
ActionA nutrition and hydration assessment at admission and quarterly, including swallow screen, preferences, cultural needs, and ability to eat independently. Individual diet cards in the kitchen and at the dining table. Food and fluid charts for at-risk residents record actual amounts. Hydration rounds every two hours with a target of 1.5 litres daily. The dietitian reviews charts weekly and adjusts. Meals are protected time; residents needing assistance are helped one-to-one.
AfterThe Monitor reviewed 20 nutrition assessments, food and fluid charts with actual amounts, dietitian review records, and the hospital admission rate for dehydration (zero in six months). Observed a protected mealtime. Verified.

If you are starting from zero — do this first

  1. Pull the weights of every resident for the last three months. Who lost weight? Was it noticed?
  2. Assess every resident's nutrition, swallow, and preferences.
  3. Record actual amounts eaten and drunk for anyone at risk.
  4. Start hydration rounds and protected mealtimes.
The most common mistake: Recording 'ate well' — a resident who ate half a slice of toast 'ate well' by the standards of a busy assistant.

Self-assessment questions

1. Does every resident's diet reflect their individual nutritional and special dietary needs, not a uniform standard menu? — Genuine individualization, not a single menu applied regardless of individual requirements.
Evidence: Individual nutrition plan documentation
2. Is assistance with eating and drinking actively provided to residents who need it, not left for the resident to manage alone? — Real, active assistance, not passive availability of food and drink alone.
Evidence: N/A — tested directly
3. Is a qualified dietitian or nutrition professional genuinely involved in developing individual nutrition plans? — Genuine professional involvement, not a generic plan without individual clinical input.
Evidence: Dietitian involvement record

Common reasons for a PARTIAL answer

  • Special dietary needs are accommodated for major conditions but not consistently for less common ones. — Every documented dietary need carries real risk if genuinely unaddressed, not only the most common ones.
  • Assistance is provided but rushed during busy mealtime periods. — Rushed assistance can result in inadequate intake even when technically provided.
  • Dietitian involvement happens at initial assessment but isn't revisited as a resident's condition changes.

Implementation plan

When What
Week 1 Review current nutrition planning for genuine individualization versus standardized menus.
Week 2 Strengthen dietitian involvement in individual nutrition plan development.
Week 3 Observe and address mealtime assistance practice, particularly during busy periods.
Ongoing Revisit nutrition plans as resident condition changes.

How the Monitor verifies this

Method What Detail
DOCUMENT Individual nutrition plan review Reviews nutrition plans for a sample of residents for genuine individualization.
OBSERVE Eating and drinking assistance observation Observes an actual mealtime for genuine, active assistance to residents who need it.
DOCUMENT Dietitian involvement review Reviews evidence of genuine dietitian or nutrition professional involvement in individual plans.

Supervisor tips

  • Observe an actual mealtime, particularly for residents who need eating assistance. — Direct observation reveals whether assistance is genuine and adequate, not rushed or assumed.
  • Ask how a specific resident's special dietary need is actually accommodated in practice. — A specific, real answer reveals genuine individualization, not policy language alone.

Evidence base

[12] Established long-term care regulatory principles, recognized in various forms across many countries' care standards, require the facility to provide each resident a nourishing, palatable, well-balanced diet meeting individual nutritional and special dietary needs, with assistance provided as needed.

ASF training courses on GMJ Academy →

Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.

3.3

Weight Loss Is Caught Early, Using a Specific Threshold

Non-Negotiable

Resident weight is monitored on a defined schedule, with a specific, recognised threshold for significant weight loss triggering immediate clinical review — not weight changes noticed informally or only after they become visually apparent.

In plain terms: Every resident is weighed on a set schedule, and a specific threshold — 5% in a month, 10% in six months — triggers an investigation, not a note in the file.

Facility category Crisis Transition Small Standard
Applicability Adapted Full Full Full

Why this matters

Weight loss is the earliest measurable sign of almost everything that goes wrong in a care home resident: cancer, depression, dysphagia, poor food, dental pain, medication side effects, neglect. Caught at 5%, it is reversible; at 15%, the resident is frail, immobile, and dying. Weighing monthly (weekly for at-risk) with a defined threshold — the internationally recognised 5% in 30 days or 10% in 180 days — that automatically triggers a review (dietitian, physician, medication, mood, oral health) turns weight into an early warning system. Weighing without a threshold is data without a purpose.

What good looks like

  • Weight is monitored on a defined, consistently followed schedule.
  • The specific threshold reliably triggers immediate clinical review.
  • Monitoring frequency genuinely increases once significant loss is identified.

Common failure modes

  • Weight monitoring is irregular or informal.
  • The threshold, even when met, doesn't reliably trigger review.
  • Monitoring frequency doesn't change after significant weight loss is identified.

Worked example

In practice
A 60-bed care home that weighed residents 'regularly.'
BeforeWeights were taken when someone remembered — gaps of three to six months were common. There was no threshold and no automatic response. The Coordinator reviewed 30 residents: 8 had lost more than 10% in six months; 2 had lost over 20%. None had a documented investigation.
ActionA weighing protocol was written: every resident monthly on the same calibrated scale, weekly if at risk; weights entered in a register that automatically flags 5%/30-day or 10%/180-day loss; a flag triggers a review within 7 days covering intake, swallow, mood, oral health, medications, and disease; the outcome is a care plan change or a physician referral. The register is reviewed by the nurse manager weekly.
AfterThe Monitor reviewed the register with monthly weights for all residents, 12 flagged cases each with a documented review and action, and the calibration record for the scale. Verified.

If you are starting from zero — do this first

  1. Pull every resident's weights for six months. Who has lost 5% or more?
  2. Weigh everyone monthly on one calibrated scale.
  3. Set the 5%/30-day and 10%/180-day thresholds in a register.
  4. Investigate every flag within a week.
The most common mistake: Weighing residents and filing the number — without a threshold and a response, the weight is just a number.

Self-assessment questions

1. Is resident weight monitored on a defined, regular schedule, not informally or irregularly? — A specific, scheduled monitoring interval, not ad hoc weighing.
Evidence: Weight monitoring schedule and record
2. Does the specific 5% in 30 days or 10% in 180 days threshold trigger immediate clinical review? — A specific, recognised threshold, not a vague sense that weight loss seems concerning.
Evidence: Significant weight loss response record
3. Once significant weight loss is identified, does monitoring frequency genuinely increase? — Real, increased monitoring, not the same schedule continued regardless.
Evidence: N/A — tested directly

Common reasons for a PARTIAL answer

  • Monthly weighing happens consistently but the specific percentage calculation isn't always performed. — Recording weight without calculating against the specific threshold misses the actual early-warning value.
  • Clinical review happens for weight loss but not consistently within a genuinely prompt timeframe. — The protective value of early identification depends on genuinely prompt follow-up, not eventual review.
  • Increased monitoring is ordered but not consistently followed through in practice.

Implementation plan

When What
Week 1 Review current weight monitoring schedule and threshold calculation practice.
Week 2 Establish consistent, systematic threshold calculation against the specific benchmark.
Week 3 Establish a defined, prompt clinical review process triggered by the threshold.
Ongoing Audit monitoring frequency increases following identified significant weight loss.

How the Monitor verifies this

Method What Detail
DOCUMENT Monitoring schedule review Reviews the weight monitoring schedule and actual adherence to it.
DOCUMENT Threshold response review Reviews records for genuine, immediate clinical review when the significant weight loss threshold is met.
DOCUMENT Increased monitoring review Reviews whether monitoring frequency genuinely increases after significant weight loss is identified.

Supervisor tips

  • Ask for a specific, real example of significant weight loss and the resulting clinical response. — A real example reveals whether the threshold genuinely triggers action, not just gets recorded.
  • Check whether the specific percentage calculation is actually performed, not just weight recorded. — This is the precise mechanism that makes early identification possible.

Evidence base

[13] Established long-term care clinical practice recognizes significant unintended weight loss — commonly defined as approximately 5 percent in 30 days or 10 percent in 180 days — as a threshold requiring active identification, response, and increased monitoring frequency once loss is identified.

ASF training courses on GMJ Academy →

Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.

3.4

Food and Activities Reflect Genuine Cultural and Personal Preference

Core

Food and activities genuinely reflect each resident's cultural, religious, and personal preferences — with documented, active effort to learn these preferences even from a resident with dementia or communication barriers, not a standardized program applied uniformly regardless of individual background.

In plain terms: The food and the activities reflect who each resident actually is — their culture, religion, and personal preferences — and the home makes a real effort to find out and accommodate.

Facility category Crisis Transition Small Standard
Applicability N/A Full Adapted Full

Why this matters

A Muslim resident served pork. A Hindu resident served beef. A Jewish resident with no kosher option. A resident who loved gardening offered bingo. A resident who has always eaten rice offered potatoes daily. These are not small things: food and meaningful activity are what make a place a home, and their absence makes it an institution. The effort must be documented: a preference assessment at admission, a kitchen that can accommodate, an activities programme built from what residents actually want, and a periodic check that it is happening. 'We treat everyone the same' means everyone gets the majority's food.

What good looks like

  • Food and activities genuinely reflect individual cultural, religious, and personal preferences.
  • Active, documented effort exists to learn preferences from residents with communication barriers.
  • Learned preferences are genuinely reflected in practice, not just recorded.

Common failure modes

  • A standardized program is applied uniformly regardless of individual background.
  • No documented effort exists to learn preferences from residents with communication barriers.
  • Preferences are recorded but not genuinely acted on.

Worked example

In practice
A 50-bed care home in a diverse city with a single Western menu and a standard activities calendar.
BeforeThe menu was the same for everyone. Three Muslim residents were served food they could not eat and lost weight. A Hindu resident's family brought all his food. Activities were bingo, films, and singalongs; participation was under 30%. No preference assessment existed.
ActionA cultural and personal preference assessment was added to admission: dietary laws, food preferences, faith practices, lifelong interests, meaningful roles. The kitchen introduced halal, kosher-style, and vegetarian options and a weekly meal from a resident's culture. Activities were rebuilt from the assessments: a gardening group, a men's club, a faith service, a cooking group, individual interest pursuits. Participation is tracked and preferences reviewed quarterly with the resident.
AfterThe Monitor reviewed 20 preference assessments, the diversified menu, the activities calendar built from resident interests, and participation data (30% → 68%). Interviewed a Muslim resident who described the food as 'finally mine.' Verified.

If you are starting from zero — do this first

  1. Ask ten residents what they miss most about food and activities from their life before.
  2. Add a preference assessment to admission.
  3. Change one meal a week to a resident's culture.
  4. Replace one generic activity with one built from stated interests.
The most common mistake: Offering a standard menu and calendar and expecting residents to adapt — they are at home; the home should adapt.

Self-assessment questions

1. Do food and activities genuinely reflect individual residents' cultural, religious, and personal preferences? — Genuine, individual reflection, not a standardized program applied uniformly.
Evidence: Preference accommodation documentation
2. For residents with dementia or communication barriers, is there documented, active effort to learn their preferences? — Specific, documented effort, not an assumption that preferences can't be learned.
Evidence: Preference-learning documentation for residents with communication barriers
3. Are learned preferences actually reflected in what's provided, not just recorded without follow-through? — Genuine follow-through, not preferences noted but not actually acted on.
Evidence: N/A — tested directly

Common reasons for a PARTIAL answer

  • Major religious dietary requirements are accommodated but more individual personal preferences are not. — Personal, non-religious preferences still carry real meaning for a resident's daily quality of life.
  • Effort to learn preferences happens at admission but isn't revisited as dementia progresses and communication changes. — A resident's ability to express preference, and preferences themselves, can genuinely change over time.
  • Preferences are documented but the connection between documentation and actual daily provision is inconsistent.

Implementation plan

When What
Week 1 Review current preference accommodation for genuine individualization versus standardized programming.
Week 2 Establish a specific, documented process for learning preferences from residents with communication barriers.
Week 3 Build a clear connection between documented preferences and actual daily food and activity provision.
Ongoing Revisit preference documentation as residents' communication ability changes.

How the Monitor verifies this

Method What Detail
DOCUMENT Preference accommodation review Reviews evidence that food and activities genuinely reflect individual resident preferences.
DOCUMENT Communication barrier effort review Reviews documented effort to learn preferences from residents with dementia or communication barriers.
OBSERVE Follow-through observation Checks whether documented preferences are genuinely reflected in what's actually provided.

Supervisor tips

  • Ask staff how they learned a specific resident's preferences, particularly one with dementia. — A specific, real example reveals genuine effort, not an assumption preferences can't be learned.
  • Compare documented preferences against what's actually provided to a specific resident. — This reveals whether documentation translates into genuine practice.

Evidence base

[14] The United Nations Principles for Older Persons establish that older persons should be able to live in environments adaptable to personal preferences, a principle reflected in established long-term care practice as the facility's responsibility to make reasonable efforts to learn and accommodate each resident's cultural and personal food preferences, including documented steps to learn preferences from residents facing barriers to expressing them directly.

ASF training courses on GMJ Academy →

Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.

3.5

A Qualified Activities Program Provides Genuine Social Engagement

Core

The facility provides an ongoing activities program led by a genuinely qualified activities professional, offering real, varied social and recreational engagement — not passive entertainment like a television left on, or a program that exists on paper without genuine resident participation.

In plain terms: The home runs a real activities programme led by someone qualified to do it, with varied things to do every day — not a television and an occasional singalong.

Facility category Crisis Transition Small Standard
Applicability N/A Full Adapted Full

Why this matters

Boredom in a care home is not a nuisance; it is a cause of depression, agitation, decline, and death. A resident with nothing to do sits in a chair, stops moving, stops talking, stops eating. A qualified activities coordinator — trained in gerontology, occupational therapy, or a recognised activities qualification — designs a programme that meets residents' cognitive, physical, social, and spiritual needs: exercise, creative work, outings, music, faith, conversation, one-to-one for those who cannot join groups. The programme runs every day including weekends, is documented, and is evaluated by participation and resident feedback.

What good looks like

  • The activities program is led by a genuinely, verifiably qualified professional.
  • The program offers real, varied engagement matched to individual interests.
  • Genuine resident participation is observed, not just programmed availability.

Common failure modes

  • The activities role is filled informally without meeting defined qualification criteria.
  • The program defaults to passive entertainment with little genuine variety.
  • Activities exist on the schedule but residents don't genuinely participate.

Worked example

In practice
A 60-bed care home where activities were run by a care assistant when she had time.
BeforeActivities happened two or three afternoons a week: television, bingo, occasional music. No weekend activities. Residents with dementia or immobility were excluded. No one on the staff had activities training. Participation was under 25%; most residents spent the day in a chair.
ActionA qualified activities coordinator (accredited course) was appointed. A seven-day programme was built with morning and afternoon sessions: exercise, art, music, gardening, reminiscence, faith, outings, and structured one-to-one for residents who cannot join groups. Care assistants received activities training and support sessions. Participation is recorded per resident; the programme is reviewed monthly with the residents' council.
AfterThe Monitor reviewed the seven-day programme, the coordinator's qualification, participation records (25% → 75%), and one-to-one records for bedbound residents. Observed a morning exercise group. Verified.

If you are starting from zero — do this first

  1. Count how many residents took part in an activity yesterday. And on Saturday.
  2. Appoint or train a qualified activities coordinator.
  3. Build a seven-day programme with something every morning and afternoon.
  4. Record who participates and review monthly.
The most common mistake: Counting the television as an activity.

Self-assessment questions

1. Is the activities program led by a genuinely qualified activities professional meeting defined qualification criteria? — Specific, verified qualification, not simply a staff member assigned the role informally.
Evidence: Activities professional qualification record
2. Does the program offer real, varied engagement matched to individual resident interests, not passive entertainment alone? — Genuine variety and individual relevance, not a single default activity like television.
Evidence: Activities program schedule and content
3. Is genuine resident participation observed, not just a program that exists on paper? — Real, observed participation, not activities offered without residents actually engaging.
Evidence: N/A — tested directly

Common reasons for a PARTIAL answer

  • The activities professional is qualified but the program isn't adapted for residents with significant cognitive impairment. — Meaningful engagement needs to be genuinely accessible to residents across the full range of cognitive ability.
  • Variety exists on the schedule but actual attendance is concentrated in a small group of residents. — A program's real value depends on genuinely reaching residents broadly, not just being available.
  • Group activities are offered but residents who prefer individual engagement have fewer genuine options.

Implementation plan

When What
Week 1 Review activities professional qualification against defined criteria.
Week 2 Assess program variety and adaptation for residents with cognitive impairment.
Week 3 Establish tracking of genuine resident participation, not just program offerings.
Ongoing Review participation patterns and adjust programming to reach residents more broadly.

How the Monitor verifies this

Method What Detail
DOCUMENT Activities professional qualification review Reviews the qualification of the person leading the activities program against defined criteria.
DOCUMENT Program content review Reviews the activities program schedule for genuine variety matched to resident interests.
OBSERVE Participation observation Observes an actual activity for genuine resident participation, not passive presence alone.

Supervisor tips

  • Observe an actual activity session directly, watching for genuine participation, not passive presence. — Direct observation reveals whether engagement is real, not just scheduled.
  • Ask to see the activities professional's specific qualification credentials. — Specific, verifiable credentials are the real evidence of genuine qualification, not an assumed title.

Evidence base

[15] The United Nations Principles for Older Persons establish that older persons should be able to pursue opportunities for the full development of their potential and remain integrated in society, a principle reflected in established long-term care practice as requiring an ongoing activities program directed by a qualified activities professional to meet the interests and support the physical, mental, and psychosocial well-being of each resident.

ASF training courses on GMJ Academy →

Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.

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