ASF Standards · Long-Term Care · Standard 11

Standard 11 — Sustainable Care

7 criteria · 2 core · 5 standard-level · Version 1.0 · Aligned to ISQua EEA Principle 6, 6th Edition

Criteria in this standard

11.1 — Environmental Impact Is Genuinely Assessed Across a 24-Hour Operation
11.2 — Clinical and Incontinence Waste Is Genuinely Segregated and Responsibly Disposed
11.3 — Procurement Genuinely Considers Environmental Impact
11.4 — Energy and Water Use Are Genuinely Monitored and Reduced Where Possible
11.5 — Residents, Families, and Staff Are Genuinely Engaged in Sustainability Practice
11.6 — The Facility Genuinely Plans for Climate-Related Risk to Resident Safety
11.7 — Sustainability Commitments Are Genuinely Reviewed, Not Static

11.1

Environmental Impact Is Genuinely Assessed Across a 24-Hour Operation

Standard

The facility genuinely assesses its environmental impact — energy, water, laundry, and food service consumption — reflecting the real, continuous nature of residential operation, not a partial assessment that overlooks the facility’s round-the-clock resource use.

In plain terms: The facility has actually looked at its real environmental footprint across everything it does around the clock — not a partial picture that misses laundry, food, and overnight resource use.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

A long-term care facility operates fundamentally differently from a clinic or hospital in one crucial respect: it is a residence, running continuously, with laundry, food service, heating, and cooling needs that never pause. These functions are often the facility’s largest resource consumers by far, yet an environmental assessment that focuses narrowly on clinical operations — mirroring a hospital’s approach — can miss them entirely. A genuine assessment has to reflect what the facility actually is: a 24-hour home for its residents.

What good looks like

The assessment genuinely reflects the full 24-hour operation, not a partial snapshot.
Laundry and food service are genuinely included, not overlooked as outside scope.
The assessment is genuinely revisited periodically.

Common failure modes

An assessment covers only clinical areas, missing the facility’s largest resource users.
Laundry volume and energy use have never been actually examined.

Worked example

In practice

A 60-bed facility that had only ever reviewed clinical supply costs.

BeforeThe facility’s only “environmental review” had looked at medical supply packaging, never touching the on-site laundry operation running multiple loads daily or the kitchen’s food waste volume.

ActionA genuine baseline was compiled covering laundry water and energy use, kitchen food waste, and overall utility consumption, revealing laundry as by far the facility’s largest water consumer.

AfterThe Monitor reviewed the comprehensive baseline, confirming it genuinely covered laundry and food service alongside clinical areas. Verified.

If you are starting from zero — do this first

Pull utility, laundry, and food service data for the past 12 months.
Compile a baseline that genuinely reflects the facility’s full, continuous operation.

The most common mistake: Treating environmental assessment as a clinical exercise, missing laundry and food service — the facility’s actual largest resource consumers.

Self-assessment questions

1. Has the facility genuinely assessed its environmental impact across its full 24-hour operation? — A real, comprehensive assessment, not a partial snapshot.
Evidence: Baseline assessment document

2. Does this genuinely include laundry and food service? — Real coverage of the facility’s actual largest resource users.
Evidence: Laundry/food service data

3. Is the assessment genuinely revisited periodically? — Real, periodic review.
Evidence: Review schedule

Common reasons for a PARTIAL answer

Clinical areas are assessed but laundry and food service are overlooked.

Implementation plan

When	What
Week 1-2	Compile a comprehensive baseline covering laundry, food, and utilities.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Baseline review	Reviews the baseline for genuine, comprehensive coverage including laundry and food.

Supervisor tips

Specifically ask whether laundry has ever been included in an assessment.

Evidence base

World Health Organization. WHO Guidance for Climate-Resilient and Environmentally Sustainable Health Care Facilities. Geneva: WHO; 2020.

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.

11.2

Clinical and Incontinence Waste Is Genuinely Segregated and Responsibly Disposed

Standard

Clinical, hazardous, and high-volume incontinence waste is genuinely segregated at the point of generation and disposed of through a responsible, verified pathway — not a waste stream mixed for convenience given the facility’s continuous, high-volume generation.

In plain terms: Medical and incontinence waste is kept genuinely separate from regular trash, right from when it’s generated, and goes somewhere genuinely responsible.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

A long-term care facility generates genuinely high, continuous volumes of incontinence and clinical waste compared to a clinic that sees patients episodically — and this real, daily volume makes correct segregation and disposal a sustained operational discipline, not an occasional task. Under staffing pressure during busy shift periods, segregation is often exactly the practice that quietly lapses first.

What good looks like

Clinical and incontinence waste is genuinely segregated consistently, including under staffing pressure.
The disposal pathway is genuinely verified.
Care staff are genuinely trained with real, observable compliance.

Common failure modes

Segregation lapses during busy shift changes or staffing shortages.

Worked example

In practice

A facility where segregation reliably lapsed during the busy morning care routine.

BeforeDuring the rushed morning personal care routine, staff frequently used whatever bin was closest, mixing incontinence waste with general waste.

ActionDedicated, clearly marked bins were placed in every resident room, removing the need to travel to a shared bin during the busy morning routine.

AfterThe Monitor observed correct segregation during an actual morning care routine, the busiest and highest-risk period. Verified.

If you are starting from zero — do this first

Place dedicated segregation bins in every resident room, not shared corridor bins.

The most common mistake: Segregation bins placed too far from the point of actual care, making correct use genuinely inconvenient during busy periods.

Self-assessment questions

1. Is clinical and incontinence waste genuinely segregated at every point of generation? — Real, consistent segregation, not a practice that lapses under staffing pressure.
Evidence: Direct observation during busy periods

2. Is the disposal pathway genuinely verified? — A real, verified pathway.
Evidence: Contractor verification record

3. Are care staff genuinely trained with real, observable compliance? — Real, demonstrated practice during actual resident care routines.
Evidence: Training record, observation

Common reasons for a PARTIAL answer

Segregation holds up during quiet periods but lapses during the busiest shifts.

Implementation plan

When	What
Week 1	Place dedicated bins in every resident room.

How the Monitor verifies this

Method	What	Detail
ASK	Direct observation	Observes segregation during an actual busy care period, not a quiet moment.

Supervisor tips

Observe during the morning care routine specifically, the highest-risk period.

Evidence base

World Health Organization. Safe Management of Wastes from Health-Care Activities. Geneva: WHO; 2014.

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.

11.3

Procurement Genuinely Considers Environmental Impact

Core

Procurement decisions genuinely factor in environmental impact alongside cost and resident need — including the facility’s recurring, high-volume purchases of continence products, bedding, and food supplies — not sustainability treated as an afterthought with purchasing decided purely on price.

In plain terms: When the facility buys its ongoing, large-volume supplies — continence products, bedding, food — it actually thinks about environmental impact as one real factor, not purely the cheapest option.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

A long-term care facility’s highest-volume recurring purchases — continence products, bedding, catering supplies — carry a genuinely significant cumulative environmental footprint given the sheer, continuous volume consumed. This is marked Core because these are precisely the purchases where environmental consideration, applied consistently, has the greatest real impact; a facility can hold stated sustainability values while every actual high-volume purchasing decision ignores them entirely.

What good looks like

Environmental impact is genuinely weighed for the highest-volume purchases.
A real, documented instance shows environmental considerations genuinely influencing a purchase.
Food service and catering are genuinely reviewed for waste reduction.

Common failure modes

High-volume supplies are purchased purely on unit cost with no environmental factor considered.

Worked example

In practice

A facility reviewing its continence product supply contract.

BeforeContinence product supply was renewed annually on price alone, with no consideration of packaging volume or supplier sustainability credentials.

ActionThe next supply renewal included environmental factors in the evaluation criteria, and a lower-packaging-waste supplier was selected at a comparable price point.

AfterThe Monitor reviewed the documented decision showing environmental considerations genuinely influencing the choice. Verified.

If you are starting from zero — do this first

Add environmental consideration to the evaluation criteria for the facility’s highest-volume supply contracts.

The most common mistake: High-volume, recurring purchases renewed on autopilot, with environmental impact never actually entering the evaluation.

Self-assessment questions

1. Does procurement genuinely weigh environmental impact for the facility’s highest-volume purchases? — Real, documented consideration for the purchases that actually matter most at scale.
Evidence: Procurement criteria documentation

2. Is there a real, documented instance of a procurement choice genuinely influenced by environmental considerations? — A concrete, real example.
Evidence: Specific purchasing decision record

3. Are food service and catering choices genuinely reviewed for waste reduction opportunities? — A real, ongoing review given recurring daily volume.
Evidence: Food service review record

Common reasons for a PARTIAL answer

Environmental consideration happens for some supply categories but not the highest-volume ones.

Implementation plan

When	What
Week 1-2	Add environmental criteria to high-volume supply contract evaluations.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Procurement record review	Reviews a high-volume purchasing decision for documented environmental consideration.

Supervisor tips

Ask about the facility’s largest-volume supply contract specifically.

Evidence base

NHS England. Delivering a Net Zero National Health Service. London: NHS England; 2022.

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.

11.4

Energy and Water Use Are Genuinely Monitored and Reduced Where Possible

Standard

The facility genuinely monitors its energy and water consumption, pursuing real, achievable reductions — balanced against the genuine, non-negotiable need to maintain resident comfort and safety temperatures around the clock, not efficiency pursued at the expense of resident wellbeing.

In plain terms: The facility actually tracks what it spends on energy and water, and takes real steps to use less where that’s genuinely possible — but never at the expense of keeping residents genuinely warm, cool, and comfortable.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

Energy efficiency in a long-term care setting carries a genuine tension that doesn’t exist in most other facility types: older residents are often more vulnerable to temperature extremes, and a cost-driven efficiency measure that compromises genuine thermal comfort or safety is not a real improvement — it’s a real risk relocated. Genuine efficiency here means pursuing improvements that save resources without ever compromising resident safety or comfort, not efficiency pursued regardless of that cost.

What good looks like

Consumption is genuinely tracked.
Efficiency improvements genuinely preserve resident comfort and safety.
Progress is genuinely reviewed periodically.

Common failure modes

An efficiency measure compromises resident thermal comfort to save on costs.

Worked example

In practice

A facility considering a thermostat reduction for cost savings.

BeforeA proposal to lower winter thermostat settings by two degrees to cut heating costs had not been checked against actual resident comfort needs or clinical guidance on safe ambient temperatures for older residents.

ActionInstead, the facility pursued window insulation upgrades, achieving a genuine, comparable energy saving without any reduction in resident comfort temperature.

AfterThe Monitor reviewed the energy data showing the genuine saving, with resident temperature settings unchanged. Verified.

If you are starting from zero — do this first

Set up basic consumption tracking.
Pursue efficiency improvements that don’t touch resident comfort temperatures first.

The most common mistake: Pursuing a cost-saving efficiency measure that compromises genuine resident thermal comfort or safety.

Self-assessment questions

1. Is energy and water consumption genuinely tracked? — Real, ongoing tracking.
Evidence: Consumption tracking record

2. Has the facility genuinely pursued an improvement that does not compromise resident comfort? — A real, concrete improvement balanced against genuine resident wellbeing.
Evidence: Specific improvement record

3. Is progress genuinely reviewed periodically? — Real, periodic review.
Evidence: Review schedule

Common reasons for a PARTIAL answer

Tracking exists but efficiency measures have never actually been pursued.

Implementation plan

When	What
Week 1-2	Set up consumption tracking and identify a comfort-neutral improvement.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Tracking review	Reviews consumption data and confirms resident comfort was never compromised.

Supervisor tips

Specifically ask whether any efficiency measure ever affected resident temperature settings.

Evidence base

International Finance Corporation. Greenhouse Gas Emissions Reduction in Healthcare Facilities. Washington DC: IFC; 2021.

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.

11.5

Residents, Families, and Staff Are Genuinely Engaged in Sustainability Practice

Standard

Staff genuinely understand and participate in the facility’s sustainability practices, and residents and families are genuinely made aware of relevant initiatives where appropriate — not a sustainability policy known only to management with no real engagement from the people who actually live there or care for them.

In plain terms: Staff actually know what the facility is doing to be more sustainable and genuinely take part — and residents and families know about it too, where that’s genuinely appropriate.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

A long-term care facility is, genuinely, residents’ home — which makes sustainability a shared, lived practice rather than a purely operational policy. Residents and families who are genuinely informed about relevant initiatives, where appropriate, often respond positively, and staff who genuinely understand and participate in sustainability practice are far more likely to sustain it in real, daily routines rather than it existing only as a management-level aspiration.

What good looks like

Staff can genuinely describe a real sustainability practice.
Residents and families are genuinely made aware where appropriate.
Staff input is genuinely sought and considered.

Common failure modes

Staff are unaware of any specific sustainability practice.

Worked example

In practice

A facility whose sustainability efforts were known only to the administrator.

BeforeA switch to a lower-waste continence product line had happened, but care staff were unaware of the change or its rationale.

ActionA brief team briefing explained the change, and a small newsletter note informed families, with positive feedback received.

AfterThe Monitor asked a care staff member who could describe the change and its reasoning. Verified.

If you are starting from zero — do this first

Brief staff on current sustainability practices.

The most common mistake: Sustainability decisions known only at management level, never communicated to the staff and families who are genuinely part of daily facility life.

Self-assessment questions

1. Can staff asked directly describe a genuine sustainability practice? — Real, demonstrated staff awareness.
Evidence: Staff interview

2. Are residents and families genuinely made aware of relevant initiatives where appropriate? — Real, visible communication.
Evidence: Family/resident communication

3. Is staff input genuinely sought and considered? — Real, two-way engagement.
Evidence: Staff suggestion record

Common reasons for a PARTIAL answer

Day staff are aware but night staff have never been briefed.

Implementation plan

When	What
Week 1	Brief all shifts, including nights, on current practices.

How the Monitor verifies this

Method	What	Detail
ASK	Staff interview	Asks a care staff member to describe a specific practice.

Supervisor tips

Ask a night-shift staff member, not just day staff.

Evidence base

Health Care Without Harm. Global Green and Healthy Hospitals Agenda. Reston: HCWH; 2020.

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.

11.6

The Facility Genuinely Plans for Climate-Related Risk to Resident Safety

Core

The facility genuinely considers climate-related risks to the continuous safety of its residents — extreme heat, power outages affecting medical equipment and climate control, supply chain disruption — with a real, workable response, given that residents who cannot independently evacuate or self-regulate depend entirely on the facility’s preparedness.

In plain terms: The facility has actually thought through what happens to resident safety during a heatwave or power cut — a real plan, because residents here genuinely cannot just leave or manage on their own.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

This is marked Core because the stakes of climate-related disruption are genuinely different in a residential care setting than almost anywhere else: residents often cannot evacuate independently, cannot self-regulate body temperature as effectively as younger adults, and depend on the facility’s continuous climate control and power supply for basic safety, not just comfort. A power outage during a heatwave is not an inconvenience here — it is a direct, serious safety risk, and the facility’s preparedness is what stands between that risk and actual harm.

What good looks like

Specific climate-related risks to resident safety are genuinely identified.
A real, workable response plan exists, including backup power for climate control.
This plan is genuinely reviewed and tested across all shifts.

Common failure modes

No backup plan exists for climate control during a power outage.

Worked example

In practice

A facility with no backup plan for a summer power outage.

BeforeA previous summer power outage had left the facility without air conditioning for several hours, handled reactively with staff using fans, with no formal plan or backup generator capacity for critical cooling.

ActionA backup generator sized to cover at least critical climate-control zones was installed, with a documented activation protocol and a tabletop exercise conducted with staff across all three shifts.

AfterThe Monitor reviewed the generator specification and confirmed night-shift staff could describe the activation protocol. Verified.

If you are starting from zero — do this first

Identify the facility’s most significant climate-related risk to resident safety.
Build a real response plan, including backup power for critical climate control.
Test the plan with staff across all shifts, not just daytime.

The most common mistake: A response plan that has only ever been walked through with day-shift staff, leaving night and weekend staff genuinely unprepared.

Self-assessment questions

1. Has the facility genuinely identified its specific climate-related risks to resident safety? — A real, specific risk identification.
Evidence: Risk identification document

2. Is there a real, workable response plan, including backup power for climate control? — A genuine, usable plan.
Evidence: Response plan document

3. Is this plan genuinely reviewed and tested across all shifts? — Real, periodic review and testing across the full 24-hour cycle.
Evidence: Testing record across shifts

Common reasons for a PARTIAL answer

A plan exists but has never been tested with night-shift staff.

Implementation plan

When	What
Week 1-3	Build a response plan including backup power for critical climate control.
Week 4	Test the plan with staff across all shifts.

How the Monitor verifies this

Method	What	Detail
ASK	Night-shift interview	Asks a night-shift staff member to describe the emergency protocol.

Supervisor tips

Specifically ask a night-shift staff member, not just day staff.

Evidence base

World Health Organization. Operational Framework for Building Climate Resilient Health Systems. Geneva: WHO; 2015.

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.

11.7

Sustainability Commitments Are Genuinely Reviewed, Not Static

Standard

The facility’s sustainability goals and practices are genuinely reviewed and updated as circumstances change — not a document written once and never genuinely examined for whether it still reflects the facility’s actual practice.

In plain terms: The facility’s sustainability goals actually get revisited over time — not written once and left to go stale.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

A document written once and filed away stops being a genuine reflection of the facility’s real commitments as suppliers, staff, and circumstances change over time. Genuine, periodic review is what keeps sustainability commitments actually meaningful rather than a symbolic statement disconnected from the facility’s real, current practice.

What good looks like

Goals are genuinely reviewed on a real, defined schedule.
A real, documented instance shows a goal genuinely being revised.
Responsibility for review is genuinely assigned to a specific person.

Common failure modes

A document was written once and never revisited.

Worked example

In practice

A facility whose sustainability statement predated several supplier changes.

BeforeA sustainability statement written two years earlier still referenced a laundry supplier the facility no longer used.

ActionThe facility administrator was formally assigned annual review responsibility, and the first review updated the document to reflect current suppliers and practices.

AfterThe Monitor reviewed the updated, dated document showing genuine, real revisions. Verified.

If you are starting from zero — do this first

Assign named responsibility for annual review.

The most common mistake: A document nobody is specifically responsible for revisiting, so it simply never gets reviewed.

Self-assessment questions

1. Are sustainability goals genuinely reviewed on a real schedule? — A real, periodic review.
Evidence: Review schedule

2. Is there a real, documented instance of a goal genuinely being revised? — A concrete, real example.
Evidence: Revision history

3. Is responsibility genuinely assigned to a specific person? — A real, named accountability.
Evidence: Assigned responsibility documentation

Common reasons for a PARTIAL answer

A schedule exists but hasn’t actually been followed consistently.

Implementation plan

When	What
Week 1	Assign named review responsibility and conduct the first genuine review.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Revision history review	Reviews the document’s revision history for genuine, dated updates.

Supervisor tips

Ask who is specifically responsible for the review.

Evidence base

United Nations Environment Programme. Sustainable Healthcare Facilities Guidance. Nairobi: UNEP; 2022.

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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