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Accréditation Sans Frontières · ASF Health Standards 9.0

Standard 24 · Long-Term Care

33 criteria · optional module (declare to apply)

Optional module (declare to apply). 33 criteria, of which 2 non-negotiable. Each criterion is numbered 24.Y, with its classification and verification questions.

Criteria

24.1 Individualised Functional Maintenance Plan Based on Assessment

NON-NEGOTIABLE

Every resident receiving rehabilitation or restorative therapy has an individualised plan built from a documented functional assessment, oriented toward maintaining and slowing decline in function — not a generic protocol assuming an acute-recovery trajectory that does not fit a long-term care context.

VERIFICATION QUESTIONS

  1. Is a documented functional assessment performed, specifically oriented to maintenance and decline-prevention rather than assuming a return-to-baseline recovery trajectory?
    The assessment should look at maintaining function, not assume recovery to a previous baseline.
  2. Is the plan individualised to that assessment, not a standard template applied regardless of the resident's actual baseline?
    Two residents with the same diagnosis can have very different baselines.
  3. Is the plan reassessed on a defined schedule as the resident's function changes over their stay?
    Function in a long-term stay changes, and the plan must follow it.

24.2 Coordination Between Therapy and Daily Nursing Care

NON-NEGOTIABLE

Rehabilitation and restorative therapy goals are coordinated with daily nursing and care staff, so that functional gains made in therapy sessions are reinforced and carried through in everyday care, not undone by daily practices that work against the therapy plan.

VERIFICATION QUESTIONS

  1. Do daily care staff know the resident's current therapy goals, not just the therapy team working in isolation?
    Goals that only the therapy team knows cannot be reinforced in daily care.
  2. Is there a shared communication mechanism between therapy and daily care staff, not separate, unconnected documentation?
    A shared mechanism, not two records that never meet.
  3. Can daily care staff describe a specific resident's current therapy goal when asked?
    Evidence that the goals reached the people who deliver daily care.

24.3 Resident and Family Goal-Setting

CORE

Rehabilitation and functional maintenance goals are set collaboratively with the resident and, where appropriate, family, in understandable terms, with realistic expectations communicated — not goals set unilaterally by the clinical team.

VERIFICATION QUESTIONS

  1. Are goals documented as collaborative, with the resident's own input visible, not set unilaterally by staff?
    A goal-setting record that shows only staff input suggests a one-way process.
  2. Are realistic expectations communicated, including where the goal is maintaining function rather than improving it?
    Honest expectations, including that maintaining function can be a valid goal.
  3. Where the resident has cognitive impairment, is family or an authorised representative involved in goal-setting?
    Residents who cannot fully take part need someone who represents their interests.

24.4 Function Tracked With Validated Tools, Decline Flagged Early

CORE

Functional status is tracked using a validated measurement tool at defined intervals, with any meaningful decline flagged and triggering a care plan review, not relying on informal impression that may miss a gradual decline over time.

VERIFICATION QUESTIONS

  1. Is a validated, recognised functional measurement tool used, not an informal, ad hoc note?
    A validated tool gives a consistent, comparable measure over time.
  2. Is the tool applied at defined, consistent intervals appropriate to a long-term stay?
    Measurement at intervals suited to a long stay, not sporadically.
  3. Does a flagged decline trigger a documented care plan review, not just get noted without follow-through?
    A decline that is noted but not acted on is a missed early warning.

24.5 Equipment and Assistive Device Provision Matches Need

CORE

Assistive devices and equipment — mobility aids, orthotics, adaptive equipment, positioning supports — are assessed, fitted, and provided to match the resident's actual and evolving functional need, with staff trained in correct use, not a one-time provision never revisited.

VERIFICATION QUESTIONS

  1. Is equipment provision based on a documented individual assessment, not a default or convenience-driven choice?
    Equipment chosen for convenience may not fit the resident's need.
  2. Are daily care staff trained in correct use of the resident's specific equipment, not just the therapy team?
    Equipment is used most by the staff who deliver daily care.
  3. Is equipment reassessed as the resident's needs evolve over their stay, not fitted once and never revisited?
    A device that fitted at admission may not fit later.

24.6 Restraint-Free and Least-Restrictive Mobility Support

STANDARD

Mobility and functional support is provided through the least restrictive means appropriate to the resident's safety, with effort to avoid restraint or over-restriction as a substitute for adequate staffing or supervision — not restriction used as a convenience measure.

VERIFICATION QUESTIONS

  1. Is there a documented effort to use the least restrictive approach before any restriction is applied?
    Evidence of an actual effort to avoid restriction before it is applied.
  2. Is any restriction documented with a specific, individual clinical justification, not a blanket facility policy applied regardless of the resident?
    Each restriction needs its own reason, not a blanket policy.
  3. Is restriction use reviewed on a defined schedule to check whether it remains necessary?
    Restriction that is not reviewed tends to continue by default.

24.7 Environmental Impact Is Assessed Across a 24-Hour Operation

STANDARD

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

VERIFICATION QUESTIONS

  1. Has the facility assessed its environmental impact across its full 24-hour operation?
    An assessment that covers only daytime operation can miss a large share of the resource use.
  2. Does this include laundry and food service?
    Laundry and food service run continuously and use significant resources.
  3. Is the assessment revisited periodically?
    An assessment done once does not show whether consumption is changing.

24.8 Clinical and Incontinence Waste Is Segregated and Responsibly Disposed

STANDARD

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

VERIFICATION QUESTIONS

  1. Is clinical and incontinence waste segregated at every point of generation?
    Waste is only safe if it is separated where it is produced.
  2. Is the disposal pathway verified?
    A pathway that is assumed to work may not.
  3. Are care staff trained with observable compliance?
    Training recorded but not observed does not show the practice is followed.

24.9 Procurement Considers Environmental Impact

CORE

Procurement decisions 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.

VERIFICATION QUESTIONS

  1. Does procurement weigh environmental impact for the facility's highest-volume purchases?
    Recurring high-volume purchases have the largest impact.
  2. Can the facility show a recorded example of a procurement choice influenced by environmental considerations?
    A recorded decision shows that environmental impact is weighed in practice.
  3. Are food service and catering choices reviewed for waste reduction opportunities?
    Menus and portion sizes affect waste as well as cost.

24.10 Energy and Water Use Are Monitored and Reduced Where Possible

STANDARD

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

VERIFICATION QUESTIONS

  1. Is energy and water consumption tracked?
    Consumption that is not tracked cannot be reduced.
  2. Has the facility pursued an improvement that does not compromise resident comfort?
    Improvement that does not compromise comfort, rather than savings at residents' expense.
  3. Is progress reviewed periodically?
    Progress that is not reviewed is not managed.

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

STANDARD

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

VERIFICATION QUESTIONS

  1. Can staff describe a sustainability practice when asked?
    Staff can describe the practice in their own words.
  2. Are residents and families made aware of relevant initiatives where appropriate?
    Residents and families who know about initiatives can take part in them.
  3. Is staff input sought and considered?
    Staff who work with the systems often know where savings are.

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

CORE

The facility 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 workable response, because residents who cannot independently evacuate or self-regulate depend entirely on the facility's preparedness.

VERIFICATION QUESTIONS

  1. Has the facility identified its specific climate-related risks to resident safety?
    Climate risks differ by location and must be identified specifically.
  2. Is there a workable response plan, including backup power for climate control?
    The plan must cover what happens to climate control when power fails.
  3. Is this plan reviewed and tested across all shifts?
    A plan not tested across shifts may fail at night.

24.13 Sustainability Commitments Are Reviewed, Not Static

STANDARD

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

VERIFICATION QUESTIONS

  1. Are sustainability goals reviewed on a schedule?
    Goals not reviewed do not reflect current practice.
  2. Can the facility show a recorded example of a goal being revised?
    A review that never changes a goal is not testing it.
  3. Is responsibility assigned to a specific person?
    Goals with no owner are not delivered.

24.14 Digital Systems Are Evaluated Before Adoption

STANDARD

Before adopting any new digital system — care management software, family communication portal, fall-detection or monitoring technology — the facility evaluates its cost, benefit, and compatibility with existing systems, not adopted on vendor assurance with no internal evaluation.

VERIFICATION QUESTIONS

  1. Is a cost/benefit evaluation conducted before adoption?
    A system adopted on a sales pitch alone is a common source of waste and risk.
  2. Is compatibility with existing resident record systems checked?
    Systems that do not connect create duplicate or missing records.
  3. Are unintended consequences for resident care considered?
    A system that changes how staff work can affect care in ways not intended.

24.15 Digital Care Never Disadvantages a Resident or Family Who Cannot Use It

CORE

A process ensures that residents and family members who cannot use digital devices, lack internet access, or are otherwise unable to engage digitally are never disadvantaged in care communication, family updates, or resident engagement — not digital convenience purchased at the cost of connection for the residents and families least able to adapt.

VERIFICATION QUESTIONS

  1. Is there an equally functional alternative for families who cannot use digital channels?
    Families who cannot use digital channels need an equally effective route.
  2. Was a new digital service pre-tested with representative families?
    Testing with the people most affected, before launch.
  3. Is there evidence the alternative delivers equivalent engagement?
    Evidence that the alternative works for families in practice.

24.16 Technical Support Is Available for Digital Systems

STANDARD

The facility has access to technical support — in-house, vendor-provided, or contracted — for its digital systems, with testing before full implementation, not systems left running with no support behind them, which carries particular risk where fall-detection or monitoring technology is involved.

VERIFICATION QUESTIONS

  1. Does the facility have accessible support, including for safety-related systems?
    Support must be reachable for safety-related systems, not only general IT.
  2. Were testing and quality checks performed before implementation?
    Testing before live use, not after a problem.
  3. Is there a known route to support overnight?
    Overnight support matters because many residents' needs arise at night.

24.17 AI Systems Are Introduced in Line With Law and Best-Practice Guidance

STANDARD

Any artificial intelligence tool used to support fall-risk prediction, behavioural monitoring, or care planning is introduced in accordance with applicable law, or where none exists, with available best-practice guidance such as WHO's Ethics and governance of artificial intelligence for health: WHO guidance (2021) — not adopted with no reference to any external standard of responsible use.

VERIFICATION QUESTIONS

  1. Is any AI system introduced in line with applicable law?
    Verified compliance, not an assumption that general policy covers AI.
  2. Where no law exists, is introduction informed by recognised guidance?
    A referenced guidance source, not an ad hoc decision.
  3. Can the facility identify the specific governance basis, including consent?
    The basis for governance, including consent, must be known and stated.

24.18 AI Systems Are Monitored for Unintended Consequences

STANDARD

The facility monitors any AI-assisted fall-risk or behavioural tool for false alarms, missed events, and other unintended consequences — not deploying a tool and assuming it works as intended with no ongoing scrutiny, because alarm fatigue can undermine its protective purpose.

VERIFICATION QUESTIONS

  1. Is AI-assisted output audited for false alarms or missed events?
    Monitoring output for false alarms and missed events.
  2. Is alarm fatigue among staff monitored?
    Alerts that are constantly dismissed are missed when they matter.
  3. Can the facility show a recorded example of monitoring identifying an issue?
    Evidence that monitoring works in practice, not only that it exists.

24.19 Staff Are Consulted Before an AI System Is Introduced

STANDARD

Direct care staff who will respond to an AI tool's alerts are consulted before its introduction, with training needs identified and addressed — not a tool rolled out to care staff with no engagement beyond a brief notification.

VERIFICATION QUESTIONS

  1. Are staff across all shifts consulted before introduction?
    Consultation across all shifts, not only the day team.
  2. Does consultation identify training needs?
    A consultation that identifies needs with no training following it does not prepare staff.
  3. Can night staff specifically describe having been consulted?
    Night staff often respond to alerts out of hours, so their input must be recorded.

24.20 Accountability for AI-Assisted Care Is Explicitly Defined

CORE

The facility has considered and documented accountability for care decisions made with AI support — who is responsible when a fall-risk prediction or behavioural alert is wrong or missed — not leaving this as an unexamined question until an actual resident is harmed.

VERIFICATION QUESTIONS

  1. Is clinical accountability for an AI-supported decision explicitly documented?
    A documented answer, not an assumption about responsibility.
  2. Do care staff understand monitoring does not replace direct observation?
    Monitoring supports observation and does not replace it.
  3. Is there a defined process for reviewing accountability after a missed-alert incident?
    A defined review route, not an unresolved question after an incident.

24.21 Residents and Families Are Informed When Care Involves AI

STANDARD

A resident (or their family, where the resident cannot meaningfully participate) whose care involves an aspect delivered with AI system support is informed of this — not left to assume every decision was made by a human staff member alone, with disclosure treated as optional rather than a standard part of informed care.

VERIFICATION QUESTIONS

  1. Are residents and families informed when AI is involved in care?
    Disclosure to residents and families when AI contributes to care.
  2. Is this disclosure understandable, not buried in technical language?
    Plain-language disclosure residents and families can act on.
  3. Can a family member asked directly confirm they were told?
    A confirmation that disclosure reached the family, not only that it was offered.

24.22 Every Member of the Workforce Is 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 assurance of the qualifications and scope of practice their role requires — not credentialing confined to directly employed staff while agency shift-cover goes unchecked.

VERIFICATION QUESTIONS

  1. Does credential assurance extend to agency staff covering shifts?
    Agency staff are covered by the same checks as employed staff.
  2. Is each person's scope of practice verified?
    A qualification does not automatically cover every task.
  3. Is there a process if someone practises outside their verified scope?
    A corrective process, not a gap identified with no response.

24.23 Ongoing Competency Is 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 regularly evaluated, not assumed to remain current indefinitely once initial credentialing is complete.

VERIFICATION QUESTIONS

  1. Is ongoing competency evaluated, including dementia care and manual handling?
    Competency in these areas is specific to residential care and must be checked.
  2. Does evaluation cover actual current duties?
    An evaluation that does not match current duties does not show competency for them.
  3. Does a gap trigger a response?
    A gap identified with no response is not addressed.

24.24 Staff Have Access to Ongoing Education and Skill Development

STANDARD

Every workforce member has 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 afterwards.

VERIFICATION QUESTIONS

  1. Does every workforce member have ongoing access to education?
    Ongoing access, not training treated as a one-time induction.
  2. Are development opportunities offered in dementia and palliative care?
    Development in the areas residential care depends on most.
  3. Can staff describe an opportunity taken in the past year?
    A specific, recent example, not a theoretical entitlement.

24.25 Workforce Health and Safety Is Protected, Including Manual Handling

CORE

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

VERIFICATION QUESTIONS

  1. Are specific manual handling measures in place and used?
    Measures that are in place and used in practice, not only described.
  2. Is PPE available and used?
    PPE that is present but not worn gives no protection.
  3. Are vaccinations tracked?
    Vaccination status that is assumed is not verified.

24.26 Workplace Issues Raised by Staff Are Investigated and Resolved

STANDARD

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

VERIFICATION QUESTIONS

  1. Is there an accessible process for raising issues, including care-quality concerns?
    A known, usable route for raising care-quality concerns.
  2. Is there evidence of resolution?
    A documented outcome for each workplace issue raised.
  3. Are staff protected from adverse treatment?
    Protection that exists only in policy does not encourage people to speak up.

24.27 Staff Are Protected From Resident and Family Aggression

STANDARD

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

VERIFICATION QUESTIONS

  1. Does specific training cover dementia-related aggression distinctly?
    Aggression linked to dementia needs a different response from aggression from another source.
  2. Are incidents tracked and reviewed?
    Incidents that are not reviewed do not reveal patterns.
  3. Can staff describe an instance where a measure worked?
    A concrete example, not protective measures that exist only on paper.

24.28 Workforce Feedback Is Gathered and Acted On

STANDARD

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

VERIFICATION QUESTIONS

  1. Is feedback gathered across all shifts, including nights?
    Night staff are included, not only the day team.
  2. Is feedback analysed?
    Feedback that is collected and not analysed cannot show what to change.
  3. Can the facility show a recorded example of feedback leading to a change?
    A concrete change that followed from feedback.

24.29 Sick Leave and Attrition Data Inform Organisational Learning

STANDARD

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

VERIFICATION QUESTIONS

  1. Is sick leave data monitored?
    Sick leave is monitored and reviewed, not only recorded.
  2. Are reasons for leaving, including burnout, captured?
    Exit data that is not analysed cannot show what is driving departures.
  3. Can the facility show a recorded example of this data informing a change?
    A concrete change that followed from the data.

24.30 Equality, Diversity and Inclusion Across the Workforce Are Monitored

STANDARD

The organisation monitors and responds to 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.

VERIFICATION QUESTIONS

  1. Is workforce data monitored for patterns of inequity?
    Equity is checked with data, not assumed.
  2. Where a pattern is identified, is there a defined response?
    A defined response to any pattern found.
  3. Can the facility show a recorded example of this informing a change?
    A concrete example, not a statement that data exists.

24.31 End-of-Life and Palliative Care Is Planned With the Resident

CORE

Each resident's wishes for end-of-life care are recorded and reviewed with the resident and their family, and palliative care is provided to relieve suffering when it is needed.

VERIFICATION QUESTIONS

  1. Are residents' wishes for end-of-life care recorded and reviewed on a defined schedule?
    A wish that is never recorded cannot be respected.
  2. Are residents with palliative needs assessed for pain and symptoms, and is relief given and recorded?
    Untreated pain at the end of life is a preventable harm.
  3. Are staff trained in end-of-life care, and do they know how to support families?
    Families are part of the care and need support.

24.32 Advance Care Planning Is Discussed and Recorded

CORE

Residents are offered advance care planning, and decisions about resuscitation and treatment limits are recorded, reviewed, and available to every staff member who needs them.

VERIFICATION QUESTIONS

  1. Are residents offered advance care planning, with the discussion recorded?
    A decision not discussed is not known to the staff who need it.
  2. Are resuscitation and treatment-limit decisions recorded and visible to staff at the point of care?
    A decision that is hidden in a file cannot be followed.
  3. Are these decisions reviewed when the resident's condition changes?
    A decision made earlier may no longer match the resident's condition.

24.33 Death of a Resident Is Handled With Dignity and Learning

CORE

When a resident dies, the facility follows a documented process that respects the resident and supports the family and staff, and reviews the death where a review is required.

VERIFICATION QUESTIONS

  1. Is there a documented process for a resident's death, including notifying the family and the relevant authorities?
    A process that is unknown at the time of a death fails the family.
  2. Is support offered to the family and to staff involved in the death?
    Staff and families need support after a death.
  3. Are deaths reviewed where the facility's procedure or the law requires, with learning recorded?
    A review that is never done cannot change practice. ————————————————————

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