References

Numbered references below are formal citations, in Vancouver style, each individually verified against the original source before inclusion. The [N] marker on each criterion's Reference line and "The evidence" line corresponds to its number here.

1. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, require disclosure to a resident or potential resident, prior to admission, of the facility's specific characteristics and service limitations as part of a genuine admission agreement process.

2. The United Nations Principles for Older Persons (General Assembly resolution 46/91, 1991) establish that older persons residing in any care or treatment facility should enjoy full respect for their dignity, beliefs, needs, and privacy, and the right to make decisions about their care and the quality of their lives, requiring the facility to protect and promote these rights, not merely state them.

3. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, prohibit requiring a third-party guarantee of payment as a condition of admission, and require the facility to inform residents before or at admission of services available and their associated charges.

4. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, permit transfer or discharge only for specific defined reasons, require advance written notice, and require a participatory discharge plan developed with the resident and family.

5. The United Nations Principles for Older Persons establish that older persons should be able to live in dignity and security, free of exploitation and abuse, a principle reflected in established long-term care practice as the resident's right to voice grievances without retaliation and prompt facility efforts to resolve them.

6. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, require facilities to ensure the resident environment remains as free of accident hazards as possible and that each resident receives adequate supervision, assistance, and devices to prevent accidents, including falls.

7. The United Nations Principles for Older Persons establish the right of older persons to live in dignity and be free of exploitation and physical or mental abuse, a principle reflected in established long-term care practice as the resident's right to be free from physical or chemical restraints imposed for discipline or convenience, requiring the least restrictive alternative when restraint use is genuinely indicated.

8. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, require the facility to be adequately equipped with a resident call system that relays the call directly to a staff member or centralized staff work area.

9. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, require facilities to meet an applicable, recognized fire and life safety standard, including fire-rated corridor doors with positive latching hardware.

10. The United Nations Principles for Older Persons establish that older persons should be able to live in environments that are safe and adaptable to personal preferences, a principle reflected in established long-term care practice as requiring each resident room to be equipped with or located near toilet and bathing facilities supporting genuine dignity and independence.

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.

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.

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.

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.

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.

16. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, require regular licensed pharmacist review of each resident's complete drug regimen, with identified irregularities reported to the attending physician, medical director, and director of nursing, and acted upon.

17. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, prohibit psychotropic drug use unless necessary to treat a specific condition that is diagnosed and documented in the resident's clinical record.

18. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, require residents using psychotropic drugs to receive gradual dose reduction and behavioral interventions, unless clinically contraindicated, in a genuine effort to discontinue these drugs.

19. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, limit as-needed psychotropic orders to a short, defined duration, with as-needed antipsychotic orders specifically prohibited from renewal unless the attending physician or prescribing practitioner evaluates the resident for continued appropriateness.

20. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, require facilities to establish and maintain an infection prevention and control program based on the facility's own assessment, with a designated infection preventionist holding specific training.

21. Cohen-Mansfield J. The Unmet Needs Framework for understanding behavioral expressions in dementia, as applied in current long-term care practice, identifies behavior as communication of underlying emotional or physical distress rather than pathology to be suppressed, requiring identification and response to the genuine underlying need.

22. Algase DL, Beattie ERA, Antonakos C, Beel-Bates CA, Yao L. Wandering and the physical environment. Am J Alzheimers Dis Other Demen. 2010 — establishes structured, validated wandering risk assessment, including the Algase Wandering Scale, as the standard for identifying elopement and wandering risk in long-term care, distinct from informal staff judgement.

23. Individualized, proportionate elopement prevention measures, balanced against resident autonomy and freedom of movement, are established practice in long-term care dementia management, distinct from blanket facility-wide restriction applied without individual justification.

24. Tilly J, Reed P. Dementia Care Practice Recommendations for Assisted Living and Nursing Homes. Chicago: Alzheimer's Association — establishes specific, ongoing dementia care training, including communication techniques and person-centered approach, as distinct from general staff orientation, as a core practice recommendation for long-term care.

25. Edvardsson D, Winblad B, Sandman PO. Person-centered care of people with severe Alzheimer's disease: current status and ways forward. Lancet Neurol. 2008;7(4):362-367 — establishes genuine use of individual life history and personhood, not cognitive status alone, as foundational to effective person-centered dementia care.

26. The United Nations Principles for Older Persons establish the right of older persons to make decisions about their own care, a principle reflected in established long-term care practice as the resident's right to formulate advance directives, with the facility required to provide written information about these rights and to address resident complaints about facility non-compliance.

27. Established international clinical definitions of palliative care describe it as patient- and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering, addressing physical, intellectual, emotional, social, and spiritual needs, distinct from and not conditional upon a terminal diagnosis or hospice election.

28. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, require a written agreement between the facility and any hospice or palliative care service specifying which entity is responsible for each element of the resident's care.

29. Established international clinical definitions of palliative care describe anticipating, preventing, and treating suffering as central to genuine palliative practice, distinct from reactive response to reported distress alone.

30. Genuine family participation in end-of-life care decision-making, distinct from notification of decisions already made, is established practice in palliative and end-of-life care literature for both improving decision quality and supporting family wellbeing through the experience.

31. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, require sufficient nursing staff determined by resident assessments, individual care plans, and the number, acuity, and diagnoses of the facility's actual resident population.

32. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, require regular, genuinely accurate public reporting of nurse staffing information, including actual hours worked by each category of licensed and unlicensed nursing staff.

33. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, require an effective, comprehensive, data-driven quality assurance and performance improvement program with documented evidence of systematic identification, investigation, and prevention of adverse events.

34. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, establish that the governing body or executive leadership is responsible and accountable for ensuring a quality improvement program is sustained during transitions in leadership and staffing, and is adequately resourced.

35. Established long-term care regulatory principles, recognized in various forms across many countries' care standards, prohibit employing individuals with a documented, substantiated finding of abuse, neglect, exploitation, mistreatment, or misappropriation of resident property, verified through the relevant national or regional screening mechanism.

36. WHO's guidance on financial protection in health systems identifies advance cost transparency as a determinant of genuine informed consent, a principle that applies with particular force to an ongoing, long-term financial commitment arranged by a family with limited ability to reassess after placement.

37. Continuity of care and family engagement across international distance is identified in cross-border long-term care literature as requiring proactive, periodic communication, distinct from reactive updates provided only when specifically requested.

38. Professional interpreter use is consistently associated with improved comprehension, informed consent quality, and clinical outcomes compared with ad hoc interpretation by untrained bilingual staff or family members.

39. Patient and family-reported experience research in medical tourism consistently identifies logistical coordination, not clinical quality alone, as a major determinant of overall satisfaction, a principle that applies with particular force to time-limited family visits.

40. Medical and long-term care travel facilitation literature identifies documentation delays and errors as a leading cause of placement disruption for international residents, with extended-stay legal status requiring genuinely distinct documentation from short-term medical visas.

41. Cross-border patient and family redress mechanisms are identified in international medical travel governance literature as a distinct requirement from domestic complaint processes, given the specific access barriers international families face.

42. Medical and long-term care placement governance literature consistently identifies unregulated facilitator and agent networks as a distinct risk category, separate from the clinical quality of the receiving facility itself.

43. Established international consular practice recognizes that repatriation of remains across borders requires specific documentation, commonly including a mortuary or transit certificate and an authenticated local death certificate, coordinated between local authorities, the relevant embassy or consulate, and funeral directors in both countries.

44. Genuine accommodation of an international resident's own cultural, religious, and dietary practices, distinct from an assumption of adaptation to the facility's local default, is established practice in cross-cultural long-term care literature for supporting resident dignity and quality of life.

45. Distance and time zone adaptation in family communication, distinct from communication offered only at the facility's own local convenience, is established practice in international long-term care family engagement for maintaining genuine, sustainable connection.

46. WHO Competency Standard 1 (Refugee and Migrant Health: Global Competency Standards for Health Workers, 2021) requires health workers to adapt practice to migration and displacement experiences, address trauma-informed care and psychosocial needs, and support continuity of care regardless of legal status.

47. WHO Competency Standards 2 and 4 (Refugee and Migrant Health: Global Competency Standards for Health Workers, 2021) require health workers to assess and support health system literacy as distinct from condition-specific understanding, and to actively verify genuine understanding through methods such as teach-back rather than assuming comprehension from silence.

48. WHO Competency Standard 3 explicitly states health workers have a responsibility not to engage minors to facilitate interpretation, given the associated significant risk, and identifies inaccuracy, information distortion, and compromised confidentiality as documented risks of family-member interpretation generally.

49. WHO Competency Standard 5 requires engagement with broader social and community support services and effective handover of care that specifically includes cultural, language, and migration- and displacement-related considerations.

50. Nygren B, Hydén LC. Caring for older people with dementia reliving past trauma. Nurs Ethics. 2020;27(2):621-633 — documents that the onset of dementia can trigger the re-emergence of traumatic stress symptoms dormant for decades among genocide and violence survivors, and establishes that knowledge of a resident's life story enables staff to adapt care and avoid retraumatising triggers.

51. WHO Competency Standard 7 requires health workers to use evidence-informed guidelines specific to refugee and migrant health where they exist, recognise where the health needs of this population differ from the general population, and identify where evidence gaps remain.

52. WHO Competency Standards 8 and 9 (Refugee and Migrant Health: Global Competency Standards for Health Workers, 2021) require health workers to maintain structured awareness of their own biases and institutional discrimination's impact, and to engage in self-care within a supportive team environment addressing the wellbeing impacts of migration-context care.

53. WHO's Competency Standards explicitly distinguish these legal status categories throughout, noting that access to health care and legal entitlements vary meaningfully by status and by country, and that health workers need specific awareness of this rather than a single generalised assumption.

54. Genuine exploration of culturally and religiously appropriate end-of-life alternatives for residents unable to return to their country of origin, distinct from default application of local custom, is established practice in refugee and displaced-population end-of-life care literature.

55. Equal standard of care and documentation regardless of immigration or legal status, without differential record-keeping practice, is established practice in international guidance on healthcare access for migrant and refugee populations.

Established Practice — Not Attributed to a Single Source

The statements below reflect genuine, widely recognised professional consensus — drawn from accreditation frameworks, quality improvement literature, and established clinical practice broadly — but are not attributed to one specific paper or document. They are listed here, honestly and separately from the numbered citations above, rather than assigned an invented formal reference.

• Genuine family participation in end-of-life care decision-making, distinct from notification of decisions already made, is established practice in palliative and end-of-life care literature for both improving decision quality and supporting family wellbeing through the experience.
• Individualized, proportionate elopement prevention measures, balanced against resident autonomy and freedom of movement, are established practice in long-term care dementia management, distinct from blanket facility-wide restriction applied without individual justification.

Annex — ISO 9001:2015 Correlation Table

A single-place summary of every criterion's correlation to ISO 9001:2015, for anyone checking this standard's alignment without searching page by page. Criteria not listed here carry no ISO 9001:2015 correlation — this is stated honestly, not implied as a gap in the standard itself; many patient-safety and dignity criteria simply fall outside a quality-management-system standard's scope.

Index

Alphabetical, correlated to page number.

A

Activities of daily living 30, 31

Activities program 38, 39

Admission agreement 8, 9

Advance directive 63, 64

B

Background screening 82, 83

C

Call system 23, 24

D

Discharge 14, 15

E

Elopement 54, 55, 56, 57

F

Falls 19, 20

G

Governance 80, 96, 98

Grievance 16, 17

H

Hospice 65, 66, 67, 68

I

Infection control 49, 50

L

Legal status 93, 94, 107, 113, 121, 122, 125, 126

M

Migration 94, 106, 107, 112, 113, 118, 120, 125, 126

N

Nutrition 32, 33

P

Palliative care 65, 66, 68, 70

Pharmacist review 41, 42

Psychotropic 43, 44, 45, 46, 47, 48

Q

Quality improvement 78, 79, 80, 81

R

Refugee 107, 109, 112, 113, 114, 115, 116, 117, 120, 121, 122, 123, 124, 126

Repatriation 99, 100

Restraint 21, 22

S

Staffing 74, 75, 76, 77, 80, 81

T

W

Weight loss 34, 35