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Accréditation Sans Frontières

International Accreditation of Healthcare Facilities

ASF Standards · Long-Term Care · Standard 13

Standard 13 — Supporting the Care Workforce

8 criteria · 3 core · 5 standard-level · Version 1.0 · Aligned to ISQua EEA Principle 8, 6th Edition

Criteria in this standard

13.1

Every Member of the Workforce Is Genuinely Credentialed for Their Actual Role

Core

Every member of the facility’s workforce — employed carers, nurses, contracted agency staff covering shifts, and volunteers alike — has genuine assurance of the qualifications and scope of practice their role requires — not credentialing confined to directly-employed staff while agency shift-cover goes unchecked.

In plain terms: Everyone who actually cares for residents here — employed, agency, or volunteer — has had their real qualifications genuinely checked.

Facility category Crisis Transition Small Standard
Applicability Adapted Full Full Full

Why this matters

Long-term care facilities commonly rely on agency staff to cover shift gaps, and residents cannot distinguish between a permanent staff member and an agency worker — care quality and safety genuinely depend on every single person delivering care being properly credentialed, regardless of their employment relationship with the facility.

What good looks like

  • Genuine credential assurance extends to agency staff.
  • Scope of practice is genuinely verified.
  • A real corrective process exists for a scope mismatch.

Common failure modes

  • Agency staff credentials are assumed verified by the agency, never independently checked.

Worked example

In practice
A facility relying on agency staff for weekend shift coverage.
BeforeAgency staff were assumed vetted by their agency, with no independent facility-level verification of their actual qualifications before their first shift.
ActionA direct credential-verification step was added to the agency booking process, confirmed before any new agency worker’s first shift at the facility.
AfterThe Monitor reviewed verification records for recent agency placements. Verified.

If you are starting from zero — do this first

  1. Add direct credential verification to your agency staff booking process.
The most common mistake: Trusting an agency’s own vetting claims without independent verification by the facility itself.

Self-assessment questions

1. Does genuine credential assurance extend to agency staff covering shifts? — Real, consistent coverage.
Evidence: Credential verification records
2. Is each person’s scope of practice genuinely verified? — A specific, documented match.
Evidence: Scope verification record
3. Is there a real process if someone practises outside their verified scope? — A genuine corrective process.
Evidence: Correction procedure

Common reasons for a PARTIAL answer

  • Verification happens for regular agency workers but not one-off emergency cover.

Implementation plan

When What
Week 1 Add verification step to agency booking process.

How the Monitor verifies this

Method What Detail
DOCUMENT Credential review Reviews verification records for agency and employed staff alike.

Supervisor tips

  • Ask about the most recently placed agency worker specifically.

Evidence base

The Joint Commission. Credentialing and Privileging Standards for Long-Term Care. Oakbrook Terrace: TJC; 2023.

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.

13.2

Ongoing Competency Is Genuinely, Regularly Evaluated

Core

The continued competency of every workforce member — including specific competency in dementia care, safe manual handling, and medication administration appropriate to a residential setting — is genuinely, regularly evaluated, not assumed to remain current indefinitely once initial credentialing is complete.

In plain terms: Staff competency keeps getting genuinely checked — specifically including dementia care and safe manual handling, both genuinely central to this work.

Facility category Crisis Transition Small Standard
Applicability Adapted Full Full Full

Why this matters

Dementia care and manual handling techniques evolve over time, and competency in these specific areas can genuinely degrade without regular refresh — a carer’s manual handling technique from initial training years ago may not reflect current best practice, creating real risk to both residents and the carer themselves. This is marked Core because the consequences of an outdated technique are directly physical and serious for both parties.

What good looks like

  • Ongoing competency is genuinely evaluated, including dementia care and manual handling specifically.
  • Evaluation genuinely covers actual current duties.
  • A genuine gap triggers a real response.

Common failure modes

  • Manual handling technique is assumed correct from initial training, never reassessed.

Worked example

In practice
A facility where manual handling competency had not been reassessed since hire.
BeforeManual handling technique was checked once at hiring, with some staff having worked over five years with no reassessment.
ActionAn annual, hands-on manual handling competency check was introduced, directly observing actual technique during real resident transfers.
AfterThe Monitor reviewed the annual check records, confirming genuine, direct observation rather than a self-report form. Verified.

If you are starting from zero — do this first

  1. Introduce annual, direct-observation manual handling competency checks.
The most common mistake: Manual handling competency checked by self-report form rather than real, direct observation.

Self-assessment questions

1. Is ongoing competency genuinely evaluated, including dementia care and manual handling? — A real, periodic evaluation.
Evidence: Evaluation records
2. Does evaluation genuinely cover actual current duties? — A specific, role-relevant check.
Evidence: Role-specific criteria
3. Does a genuine gap trigger a real response? — A genuine corrective process.
Evidence: Correction record

Common reasons for a PARTIAL answer

  • Evaluation relies on self-report rather than direct observation.

Implementation plan

When What
Week 1-2 Introduce annual, direct-observation competency checks.

How the Monitor verifies this

Method What Detail
DOCUMENT Evaluation review Reviews evaluation for genuine, direct-observation substance.

Supervisor tips

  • Ask to see an evaluation involving actual observed technique, not a form.

Evidence base

Institute of Medicine. Health Professions Education: A Bridge to Quality. Washington DC: National Academies Press; 2003.

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.

13.3

Staff Have Genuine Access to Ongoing Education and Skill Development

Standard

Every workforce member has genuine access to ongoing education — including dementia care, palliative care, and safe manual handling refreshers — not education treated as a one-time induction event with nothing meaningful offered afterward.

In plain terms: Staff can actually keep learning after they’re hired — particularly dementia and palliative care, genuinely central to this setting’s complexity.

Facility category Crisis Transition Small Standard
Applicability Adapted Full Full Full

Why this matters

Dementia care and palliative care are genuinely complex, evolving clinical domains, and staff without ongoing education in them risk relying on outdated or incomplete approaches to some of the most sensitive, high-stakes aspects of resident care — comforting a distressed resident with dementia, or supporting a dying resident and their family.

What good looks like

  • Genuine, ongoing access to education beyond induction.
  • Real development opportunities in dementia and palliative care specifically.
  • Staff can describe a real opportunity taken.

Common failure modes

  • Education stops after initial induction, with no dementia or palliative care refresher offered.

Worked example

In practice
A facility with no ongoing dementia care education since initial induction.
BeforeStaff had received dementia care training only during their initial onboarding, with nothing offered since, despite evolving best practice.
ActionA biannual dementia care refresher was introduced, along with access to an external palliative care course for staff interested.
AfterThe Monitor interviewed staff who could describe the refresher training taken. Verified.

If you are starting from zero — do this first

  1. Introduce a biannual dementia care refresher at minimum.
The most common mistake: Treating initial dementia or palliative care training as sufficient for the duration of someone’s employment.

Self-assessment questions

1. Does every workforce member have genuine, ongoing access to education? — Real, continuing access.
Evidence: Education policy
2. Are genuine development opportunities offered in dementia and palliative care? — Real opportunities relevant to this setting.
Evidence: Training calendar
3. Can staff describe a real opportunity taken in the past year? — A real, specific example.
Evidence: Staff interview

Common reasons for a PARTIAL answer

  • Compliance training exists but genuine skill-building opportunities are rare.

Implementation plan

When What
Week 1-2 Schedule biannual dementia and palliative care refreshers.

How the Monitor verifies this

Method What Detail
ASK Staff interview Asks staff to describe recent dementia or palliative care education taken.

Supervisor tips

  • Ask specifically about dementia or palliative care training, not generic compliance.

Evidence base

World Health Organization. Global Strategy on Human Resources for Health: Workforce 2030. Geneva: WHO; 2016.

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.

13.4

Workforce Health and Safety Is Genuinely Protected, Including Manual Handling

Core

The facility genuinely protects the health and safety of its workforce — required vaccinations, personal protective equipment, and specifically real, effective prevention of manual handling injuries from resident transfers, which represent a genuinely elevated occupational risk in this setting — not staff safety treated as secondary to resident care.

In plain terms: The people caring for residents are genuinely kept safe — with specific, real attention to manual handling injuries, which happen a lot in this kind of work.

Facility category Crisis Transition Small Standard
Applicability Adapted Full Full Full

Why this matters

Manual handling injuries are genuinely one of the most common occupational injuries in long-term care, arising from repeated resident transfers, repositioning, and mobility assistance throughout every shift. This is marked Core because the cumulative physical toll on care staff is real, serious, and directly tied to how consistently proper equipment and technique are actually used — not whether a policy document exists describing them.

What good looks like

  • Real manual handling equipment is available and actually used.
  • PPE is genuinely available and used.
  • Vaccinations are genuinely tracked.

Common failure modes

  • Hoists exist but staff skip them under time pressure, manually lifting instead.

Worked example

In practice
A facility with hoists that staff frequently bypassed.
BeforeHoists were available but staff often skipped them for quicker manual transfers during busy periods, resulting in a rising rate of staff back injuries.
ActionAdditional hoists were purchased to reduce wait time for equipment access, and a refresher training specifically addressed the time-pressure temptation to skip proper technique.
AfterThe Monitor observed hoist use during an actual transfer and confirmed consistent, correct technique. Verified.

If you are starting from zero — do this first

  1. Audit actual hoist/equipment use during real transfers, not just equipment availability.
The most common mistake: Equipment present but genuinely bypassed under time pressure, with no one actually checking real, observed use.

Self-assessment questions

1. Are genuine, specific manual handling measures in place and actually used? — Real, observed use.
Evidence: Direct observation during transfers
2. Is PPE genuinely available and used? — Real, observed use.
Evidence: Direct observation
3. Are vaccinations genuinely tracked? — Real, verified tracking, particularly important given resident vulnerability.
Evidence: Vaccination records

Common reasons for a PARTIAL answer

  • Equipment is available but genuinely underused during busy shifts.

Implementation plan

When What
Week 1 Audit equipment access and actual use during transfers.

How the Monitor verifies this

Method What Detail
ASK Direct observation Observes an actual resident transfer for correct equipment use.

Supervisor tips

  • Observe a real transfer during a busy period, not a quiet moment.

Evidence base

World Health Organization. Health Worker Safety Charter. 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.

13.5

Workplace Issues Raised by Staff Are Genuinely Investigated and Resolved

Standard

A genuine process exists for investigating and resolving workplace issues raised by staff — including whistleblowing concerns about resident care quality — with real protection from adverse treatment, not a grievance process that exists on paper with no real follow-through.

In plain terms: When staff raise a concern — including about resident care quality — it actually gets looked into, and they’re genuinely protected.

Facility category Crisis Transition Small Standard
Applicability Adapted Full Full Full

Why this matters

Long-term care staff are often the first to notice declining resident care quality — understaffing, neglect, poor practice — and whistleblower protection here carries genuinely higher stakes, since residents themselves may lack the capacity or voice to raise these concerns independently. Staff who don’t trust the reporting channel will often stay silent precisely when their observations matter most.

What good looks like

  • A genuine, accessible process exists.
  • Real evidence of genuine resolution.
  • Genuine protection from adverse treatment.

Common failure modes

  • Concerns about care quality go unreported due to fear of retaliation.

Worked example

In practice
A facility where staff were reluctant to report understaffing-related care gaps.
BeforeStaff had informally mentioned concerns about understaffing affecting resident care but had not formally reported it, fearing it would be seen as complaining.
ActionAn anonymous reporting option was added, and the first report led to a genuine staffing review and schedule adjustment.
AfterThe Monitor reviewed the report and the resulting staffing adjustment. Verified.

If you are starting from zero — do this first

  1. Introduce an anonymous reporting option for care-quality concerns.
The most common mistake: Staff concerns about care quality discussed informally but never formally raised, for fear of being seen as complaining.

Self-assessment questions

1. Is there a genuine, accessible process for raising issues, including care-quality concerns? — A real, known process.
Evidence: Process documentation
2. Is there real evidence of genuine resolution? — Genuine follow-through.
Evidence: Resolution log
3. Are staff genuinely protected from adverse treatment? — Real, demonstrated protection.
Evidence: Staff interview

Common reasons for a PARTIAL answer

  • A process exists but staff don’t genuinely trust it for care-quality concerns specifically.

Implementation plan

When What
Week 1-2 Introduce or strengthen anonymous reporting option.

How the Monitor verifies this

Method What Detail
ASK Staff interview Asks staff whether they’d feel safe raising a care-quality concern.

Supervisor tips

  • Ask specifically about care-quality concerns, not just general workplace issues.

Evidence base

International Labour Organization. Violence and Harassment Convention, 2019 (No. 190). Geneva: ILO; 2019.

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.

13.6

Staff Are Genuinely Protected From Resident and Family Aggression

Standard

The facility takes genuine, concrete steps to protect staff from aggression — including behavioural aggression linked to dementia or cognitive impairment, which requires a genuinely different, trauma-informed response than aggression from a cognitively intact individual — not workplace aggression treated as an unavoidable feature of residential care.

In plain terms: Real, specific steps protect staff from aggression — including specific training for dementia-related behaviour, which needs a genuinely different, compassionate response.

Facility category Crisis Transition Small Standard
Applicability Adapted Full Full Full

Why this matters

Aggression from a resident with dementia is genuinely different in nature and appropriate response from aggression by a cognitively intact individual — it’s typically not intentional, and the correct response is trauma-informed de-escalation rather than a standard security protocol. Staff untrained in this distinction may respond in ways that escalate the situation or, conversely, may absorb real harm without recognizing it as something the facility should formally address and support them through.

What good looks like

  • Genuine, specific training covers dementia-related aggression distinctly.
  • Incidents are genuinely tracked.
  • Staff can describe a real instance where a measure worked.

Common failure modes

  • Generic de-escalation training is used with no dementia-specific component.

Worked example

In practice
A facility using generic de-escalation training with no dementia-specific component.
BeforeStaff had received only generic workplace violence training, with no specific guidance on responding to dementia-related behavioural aggression, which is a genuinely common and different situation.
ActionDementia-specific, trauma-informed de-escalation training was delivered, alongside the existing incident log being updated to distinguish dementia-related incidents.
AfterThe Monitor confirmed dementia-specific training had been delivered and reviewed the updated incident log. Verified.

If you are starting from zero — do this first

  1. Deliver dementia-specific, trauma-informed de-escalation training.
The most common mistake: Treating all workplace aggression identically, without recognizing dementia-related behavioural aggression needs a genuinely different, trauma-informed response.

Self-assessment questions

1. Does genuine, specific training cover dementia-related aggression distinctly? — Real, specific measures appropriate to this setting’s distinct risk profile.
Evidence: Training records
2. Are incidents genuinely tracked and reviewed? — Real, systematic tracking.
Evidence: Incident log
3. Can staff describe a real instance where a measure genuinely worked? — A real, concrete example.
Evidence: Staff interview

Common reasons for a PARTIAL answer

  • Training is generic rather than genuinely dementia-specific.

Implementation plan

When What
Week 1-2 Deliver dementia-specific de-escalation training.

How the Monitor verifies this

Method What Detail
DOCUMENT Training record review Reviews training for genuine, dementia-specific content.

Supervisor tips

  • Ask staff specifically about dementia-related behavioural training.

Evidence base

World Health Organization. Framework Guidelines for Addressing Workplace Violence in the Health Sector. Geneva: WHO/ILO/ICN/PSI; 2002.

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.

13.7

Workforce Feedback Is Genuinely Gathered and Acted On

Standard

The facility has a genuine, systematic approach to gathering staff feedback across all shifts — including night staff, whose voice is often overlooked — with real analysis and a genuine, implemented response, not feedback collected occasionally with no real pattern of actual improvement.

In plain terms: Staff across every shift, including nights, get genuinely asked how working here actually is, and real changes happen as a result.

Facility category Crisis Transition Small Standard
Applicability Adapted Full Full Full

Why this matters

Feedback processes scheduled during daytime hours systematically exclude night-shift staff, who make up a genuine, significant portion of a 24-hour facility’s workforce and often have genuinely distinct concerns — staffing ratios, safety during quiet hours, isolation — that day-focused surveys may never capture.

What good looks like

  • Feedback is genuinely gathered across all shifts.
  • Feedback is genuinely analysed.
  • A documented instance shows a genuine, implemented change.

Common failure modes

  • Surveys and meetings happen only during day shift.

Worked example

In practice
A facility whose staff survey had a near-zero response rate from night staff.
BeforeAn annual survey was distributed during day-shift handover meetings, meaning night staff almost never saw or completed it.
ActionThe survey was made available digitally with a genuine deadline spanning all shifts, and a brief in-person session was held specifically during a night handover.
AfterThe Monitor reviewed the survey response data showing genuine participation from night staff. Verified.

If you are starting from zero — do this first

  1. Check current feedback response rates by shift to identify any night-staff gap.
The most common mistake: Feedback processes scheduled exclusively during day shift, systematically excluding night-staff voice.

Self-assessment questions

1. Is feedback genuinely gathered across all shifts, including nights? — Real, ongoing collection reaching night staff.
Evidence: Survey response data by shift
2. Is feedback genuinely analysed? — A real, documented analysis.
Evidence: Analysis notes
3. Is there a documented instance of feedback genuinely leading to a change? — A real, concrete example.
Evidence: Change record

Common reasons for a PARTIAL answer

  • Feedback is gathered but night-staff response rate remains genuinely low.

Implementation plan

When What
Week 1-2 Redesign feedback collection to genuinely reach all shifts.

How the Monitor verifies this

Method What Detail
DOCUMENT Response rate review Reviews survey response data broken down by shift.

Supervisor tips

  • Specifically check the response rate from night-shift staff.

Evidence base

NHS England. NHS Staff Survey National Results. Leeds: NHS England; 2023.

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.

13.8

Sick Leave and Attrition Data Genuinely Inform Organisational Learning

Standard

The facility genuinely monitors staff sick leave and the real reasons people leave — a sector with genuinely elevated attrition risk from physical and emotional demand — using this to inform genuine changes supporting workforce wellbeing and retention, not attrition treated as an unexamined, unavoidable cost of doing business.

In plain terms: The facility actually looks at why staff get sick or leave — genuinely common in this physically and emotionally demanding field — and uses what it learns to make things better.

Facility category Crisis Transition Small Standard
Applicability Adapted Full Full Full

Why this matters

Long-term care is genuinely one of the sectors with the highest documented workforce attrition, driven by a real combination of physical strain, emotional demand, and often lower relative compensation compared to other healthcare settings. A facility that treats this attrition as an unavoidable, unexamined feature of the sector misses the real, actionable patterns — burnout drivers, scheduling issues, specific unit-level problems — that genuine investigation can actually surface and address.

What good looks like

  • Sick leave data is genuinely monitored.
  • Real reasons for leaving, including burnout, are actually captured.
  • A documented instance shows this data genuinely informing a change.

Common failure modes

  • High attrition is accepted as normal for the sector, with no real investigation.

Worked example

In practice
A facility with persistently high carer turnover accepted as “normal for the industry.”
BeforeCarer turnover was significantly above the facility’s own target, but this was treated as an unavoidable industry feature with no real investigation into facility-specific causes.
ActionStructured exit interviews revealed a specific, addressable pattern: inconsistent shift scheduling was a recurring, genuine complaint, leading to a scheduling policy review.
AfterThe Monitor reviewed exit interview data and the resulting scheduling policy change. Verified.

If you are starting from zero — do this first

  1. Introduce structured exit interviews rather than accepting attrition as unexamined.
The most common mistake: Accepting high attrition as a simple, unavoidable feature of the sector, rather than investigating genuinely addressable facility-specific causes.

Self-assessment questions

1. Is sick leave data genuinely monitored? — Real, ongoing analysis.
Evidence: Sick leave records
2. Are real reasons for leaving, including burnout, actually captured? — Real, specific exit data.
Evidence: Exit interview records
3. Is there a documented instance of this data genuinely informing a change? — A real, concrete example.
Evidence: Change record

Common reasons for a PARTIAL answer

  • Exit interviews happen but results are never analysed for genuine patterns.

Implementation plan

When What
Week 1-2 Introduce structured exit interviews and genuine pattern analysis.

How the Monitor verifies this

Method What Detail
DOCUMENT Exit data review Reviews exit interview records and any resulting change.

Supervisor tips

  • Ask whether attrition has ever been genuinely investigated, not just accepted.

Evidence base

International Council of Nurses. The Global Nursing Workforce and the COVID-19 Pandemic. Geneva: ICN; 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.

13.9

Equality, Diversity and Inclusion Across the Workforce Are Genuinely Monitored

Standard

The organisation genuinely monitors and responds to real patterns of equity across recruitment, work allocation, scheduling, and promotion — including across night and day shifts — not an assumption that fair treatment exists simply because no formal complaint has been raised.

In plain terms: The facility actually looks at real patterns — who gets hired, which shifts people get, who gets promoted — not just assuming things are fair because nobody has formally complained.

Facility category Crisis Transition Small Standard
Applicability Adapted Full Full Full

Why this matters

Inequity in recruitment, scheduling, or promotion can genuinely persist for years without a single formal complaint — people often don’t report a pattern they can’t fully see themselves, or don’t trust reporting to change anything. In a round-the-clock residential setting, this genuinely extends to scheduling across night and day shifts, where a pattern can be even easier to overlook. Genuine, proactive monitoring of real workforce data is what actually surfaces a pattern that individual complaints alone would likely never reveal.

What good looks like

  • Workforce data is genuinely monitored for patterns.
  • A genuine pattern triggers a real response.
  • A real instance shows monitoring informing a change.

Common failure modes

  • No formal complaint has been raised, so the organisation genuinely assumes no issue exists, with no actual data ever reviewed.

Worked example

In practice
A facility that had never reviewed its own night-shift scheduling for patterns.
BeforeShift scheduling was managed informally with no genuine review of whether certain staff consistently received less favourable night-shift assignments.
ActionA quarterly scheduling equity review was introduced, which identified and corrected a genuine, unintentional pattern.
AfterThe Monitor reviewed the review documentation and the resulting correction. Verified.

If you are starting from zero — do this first

  1. Introduce a regular review of recruitment, scheduling, and promotion data, including across all shifts.
The most common mistake: Assuming fairness exists because no one has formally complained, with no actual data ever reviewed.

Self-assessment questions

1. Is workforce data genuinely monitored for patterns of inequity? — A real, documented monitoring process.
Evidence: Monitoring protocol
2. Where a genuine pattern is identified, is there a real, defined response? — A genuine corrective process.
Evidence: Response record
3. Is there a real, documented instance of this genuinely informing a change? — A concrete, real example.
Evidence: Change record

Common reasons for a PARTIAL answer

  • Data exists but has genuinely never been reviewed specifically for equity patterns, particularly across night shifts.

Implementation plan

When What
Week 1-2 Introduce a quarterly equity review of recruitment, scheduling, and promotion data across all shifts.

How the Monitor verifies this

Method What Detail
DOCUMENT Equity review record Reviews the monitoring data and any resulting corrective action.

Supervisor tips

  • Ask to see the actual data behind the last equity review, including night-shift staff specifically.

Evidence base

World Health Organization. Gender Equity and Human Rights in the Health Workforce. Geneva: WHO; 2019.

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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