ASF Standards · Home Care · Standard 9

Standard 9 — Sustainable Care

5 criteria · 0 core · 5 standard-level · Version 1.0 · Aligned to ISQua EEA Principle 6, 6th Edition

Criteria in this standard

9.1 — Caregiver Travel Impact Is Genuinely Considered, Not Left Unexamined
9.2 — Single-Use Supplies in the Home Are Genuinely Minimised Where Clinically Safe
9.3 — Office and Administrative Operations Genuinely Consider Environmental Impact
9.4 — Caregivers Are Genuinely Engaged in Sustainability Practice
9.5 — Sustainability Commitments Are Genuinely Reviewed, Not Static

9.1

Caregiver Travel Impact Is Genuinely Considered, Not Left Unexamined

Standard

The environmental impact of caregiver travel between client homes is genuinely considered in how visits are scheduled and routed — not left entirely unexamined simply because the provider has no central facility and travel is assumed to be an unavoidable cost of the service model.

In plain terms: The provider has actually thought about the travel caregivers do between homes, not just treated it as an unavoidable, unexamined cost of doing business.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

A home care service’s travel footprint is genuinely concentrated in caregiver movement between homes, unlike a facility-based provider where most activity happens in one place. Genuine consideration of routing and scheduling is where real, meaningful impact reduction is actually achievable — and it often improves caregiver time and client continuity as a real side benefit.

What good looks like

Travel is genuinely considered in scheduling.
A real instance shows scheduling genuinely reducing travel.
Personal-vehicle travel is genuinely factored in.

Common failure modes

Scheduling is done purely by caregiver availability, with travel distance never genuinely considered.

Worked example

In practice

A provider whose scheduling ignored geography entirely.

BeforeCaregivers were assigned to clients purely by availability, sometimes resulting in long cross-town trips between consecutive visits.

ActionScheduling software was configured to genuinely weight geographic proximity alongside availability.

AfterThe Monitor reviewed scheduling data showing a real reduction in average inter-visit travel distance. Verified.

If you are starting from zero — do this first

Review current scheduling practice for genuine geographic consideration.

The most common mistake: Scheduling purely by caregiver availability, with travel distance never genuinely factored in.

Self-assessment questions

1. Is travel genuinely considered when scheduling visits? — A real, considered approach.
Evidence: Scheduling policy

2. Is there a real, documented instance of scheduling genuinely reducing travel? — A concrete, real example.
Evidence: Scheduling data

3. Is personal-vehicle travel genuinely factored into impact consideration? — A real, considered inclusion.
Evidence: Documented consideration

Common reasons for a PARTIAL answer

Geography is considered informally but not actually built into the scheduling process.

Implementation plan

When	What
Week 1-2	Review and adjust scheduling to genuinely weight geographic proximity.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Scheduling data review	Reviews scheduling records for genuine geographic consideration.

Supervisor tips

Ask a scheduler to explain how routing genuinely factors into their decisions.

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.

9.2

Single-Use Supplies in the Home Are Genuinely Minimised Where Clinically Safe

Standard

The use of single-use supplies brought into the client’s home is genuinely reviewed for opportunities to reduce waste where clinically safe to do so — not single-use treated as the unexamined default for every item regardless of genuine clinical necessity.

In plain terms: The provider has actually checked which single-use supplies are genuinely necessary versus just the unexamined default, and disposes of clinical waste from the home properly.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

Clinical waste from home visits is genuinely easy to overlook since it doesn’t accumulate visibly in one place the way facility waste does — each caregiver generates a small, dispersed stream across many separate homes. Genuine review ensures single-use items are used where clinically necessary, and disposed of properly rather than left to a client’s ordinary household waste.

What good looks like

Single-use practice has genuinely been reviewed.
Clinical safety is genuinely maintained throughout.
Clinical waste is genuinely collected and disposed of properly.

Common failure modes

Clinical waste from home visits is left in the client’s own household bin.

Worked example

In practice

A provider whose clinical waste disposal from homes was undefined.

BeforeCaregivers had no clear instruction on clinical waste disposal from client homes, and some was left in household bins.

ActionCaregivers were equipped with sealed containers to transport clinical waste back for proper disposal.

AfterThe Monitor confirmed proper disposal records. Verified.

If you are starting from zero — do this first

Establish a clear clinical waste transport and disposal protocol for home visits.

The most common mistake: Clinical waste from home visits genuinely left in the client’s own household waste with no proper disposal protocol.

Self-assessment questions

1. Has single-use supply practice been genuinely reviewed? — A real, documented review.
Evidence: Supply review

2. Is clinical safety genuinely protected throughout? — Real, maintained safety.
Evidence: Clinical protocol

3. Is clinical waste genuinely collected and disposed of properly? — Real, proper disposal.
Evidence: Disposal protocol

Common reasons for a PARTIAL answer

A disposal protocol exists but isn’t actually followed consistently by all caregivers.

Implementation plan

When	What
Week 1-2	Establish and distribute a clinical waste disposal protocol.

How the Monitor verifies this

Method	What	Detail
ASK	Caregiver interview	Asks a caregiver to describe their actual waste disposal practice.

Supervisor tips

Ask specifically what happens to clinical waste after a home visit.

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.

9.3

Office and Administrative Operations Genuinely Consider Environmental Impact

Standard

The provider’s own administrative base — office energy use, paper records, equipment — genuinely factors in environmental impact, proportionate to its real scale, not sustainability treated as inapplicable simply because most service delivery happens in clients’ homes rather than a large facility.

In plain terms: Even though most care happens in homes, the provider’s own office operations still genuinely consider their real environmental footprint, sized appropriately to how big that office actually is.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

A provider can genuinely overlook its own administrative footprint by focusing exclusively on home-based care delivery — but the office, paper records, and equipment still carry a real, if smaller, footprint worth genuine, proportionate consideration.

What good looks like

The administrative base genuinely considers its footprint.
Records genuinely minimise unnecessary paper use.
Consideration is genuinely proportionate to real scale.

Common failure modes

Sustainability is treated as entirely inapplicable because “most care happens in homes.”

Worked example

In practice

A small office that had never considered its own footprint.

BeforeThe office kept all client records on paper, with no genuine review of digital alternatives that would also support field access.

ActionA proportionate, genuine review introduced digital record-keeping for new clients, reducing both paper use and improving caregiver field access.

AfterThe Monitor reviewed the transition plan. Verified.

If you are starting from zero — do this first

Review the administrative base’s own footprint proportionate to its real size.

The most common mistake: Assuming sustainability is entirely inapplicable because most care happens outside the office.

Self-assessment questions

1. Does the administrative base genuinely consider its own impact? — A real, proportionate consideration.
Evidence: Office practice review

2. Are client records genuinely managed to minimise unnecessary paper use? — A real, considered balance.
Evidence: Record-keeping practice

3. Is this consideration genuinely proportionate to real scale? — A real, appropriately scaled approach.
Evidence: Documented review

Common reasons for a PARTIAL answer

Office practice has never actually been reviewed at all.

Implementation plan

When	What
Week 1-2	Review office practice proportionate to real scale.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Office review	Reviews documented consideration of office footprint.

Supervisor tips

Ask about this even for a very small office — the standard is proportionate, not absent.

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.

9.4

Caregivers Are Genuinely Engaged in Sustainability Practice

Standard

Caregivers genuinely understand and participate in the provider’s sustainability practices — not a policy known only to administrative staff with no real reach to a workforce that spends most of its time in clients’ homes rather than a shared office.

In plain terms: Caregivers actually know what the provider is doing to be more sustainable — not just the office staff who rarely see them.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

Caregivers genuinely spend most of their working time away from any shared office, meaning communication designed for an in-person team easily misses them entirely. Genuine engagement requires deliberate, functioning outreach appropriate to a field-based workforce.

What good looks like

Caregivers can genuinely describe a real practice.
Caregiver input is genuinely sought.
Communication genuinely reaches field-based caregivers.

Common failure modes

Updates are posted only in the office, which caregivers rarely visit.

Worked example

In practice

A provider whose updates never reached field caregivers.

BeforeSustainability updates were posted on an office noticeboard caregivers almost never saw.

ActionUpdates were moved to the provider’s existing caregiver scheduling app, genuinely reaching the field workforce.

AfterThe Monitor interviewed a caregiver who could describe a recent update. Verified.

If you are starting from zero — do this first

Check whether current communication genuinely reaches field-based caregivers.

The most common mistake: Internal communication designed around an office setting that field caregivers genuinely never see.

Self-assessment questions

1. Can caregivers describe a genuine sustainability practice? — Real, demonstrated awareness.
Evidence: Caregiver interview

2. Is caregiver input genuinely sought? — Real, two-way engagement.
Evidence: Suggestion record

3. Does communication genuinely reach field caregivers? — Real, functioning communication.
Evidence: Field caregiver interview

Common reasons for a PARTIAL answer

Office staff are aware but field caregivers genuinely are not.

Implementation plan

When	What
Week 1	Move communication to a channel that genuinely reaches field caregivers.

How the Monitor verifies this

Method	What	Detail
ASK	Caregiver interview	Asks a field caregiver to describe a specific practice.

Supervisor tips

Interview a genuinely field-based caregiver, not office staff.

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.

9.5

Sustainability Commitments Are Genuinely Reviewed, Not Static

Standard

The provider’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 actual practice.

In plain terms: The provider’s sustainability goals actually get revisited — 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 stops genuinely reflecting current practice as routing software, waste protocols, or the provider’s own scale change. Real, periodic review is what keeps the commitment meaningful.

What good looks like

Goals are genuinely reviewed.
A real revision instance exists.
Responsibility is genuinely assigned.

Common failure modes

A document was written once and never revisited.

Worked example

In practice

A provider whose sustainability statement predated its scheduling software upgrade.

BeforeThe statement made no mention of routing improvements already in effect.

ActionA named person was assigned annual review responsibility.

AfterThe Monitor reviewed the updated, dated document. Verified.

If you are starting from zero — do this first

Assign named review responsibility.

The most common mistake: A document nobody is specifically responsible for revisiting.

Self-assessment questions

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

2. Is there a real revision instance? — A concrete example.
Evidence: Revision history

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

Common reasons for a PARTIAL answer

A schedule exists but hasn’t been followed consistently.

Implementation plan

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

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Revision history review	Reviews the document’s revision history.

Supervisor tips

Ask who is specifically responsible for review.

Evidence base

World Health Organization. Global Strategy on Digital Health 2020-2025. Geneva: WHO; 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.

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