Personal Care & Daily Living
Personal Care & Daily Living
MANDATORY
5 criteria
| Standard 3.1 NON-NEGOTIABLE · Standard 3: Personal Care & Daily Living Activities of Daily Living Support Prevents Unnecessary Decline |
ASSESSMENT ASF-LTC-STD3-v3.0 |
| CR ADAPTED | TR FULL | SM FULL | ST FULL |
| 3.1 NON-NEGOTIABLE L1 |
THE STANDARD Activities of Daily Living Support Prevents Unnecessary Decline A resident's ability to perform activities of daily living — hygiene, mobility, eating, toileting — is actively supported to prevent avoidable decline, with any diminution genuinely tied to an unavoidable clinical cause, documented specifically, not assumed as a normal part of aging or long-term residence. |
| FACILITY SELF-ASSESSMENT Tick YES, PARTIAL, or NO for each question. |
| 1 | Is ADL support genuinely aimed at maintaining the resident's own ability, not simply completing the task for them? Support that maintains capability, not task completion that bypasses it. Doc: ADL care plan and approach documentation |
YES | PARTIAL | NO |
| 2 | When ADL decline occurs, is it specifically tied to a documented, unavoidable clinical cause? A specific, documented clinical reason, not an assumption that decline is simply expected. Doc: Decline documentation and clinical justification |
YES | PARTIAL | NO |
| 3 | Are care plans reviewed and adjusted as a resident's ADL ability changes, in either direction? Genuine, ongoing adjustment, not a static plan set once and left unchanged. Doc: ADL care plan review record |
YES | PARTIAL | NO |
ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.
| WHAT THE ASSESSOR DOES ON SITE no surprises, no hidden checks |
| OBSERVE ADL support practice observation |
Observes actual ADL assistance for genuine ability-maintaining support versus task completion. |
| DOCUMENT Decline documentation review |
Reviews documented ADL decline for specific, genuine clinical justification. |
| DOCUMENT Care plan review record check |
Reviews whether ADL care plans are genuinely reviewed and adjusted as ability changes. |
REFERENCES
- [11] Established long-term care regulatory principles, recognized in various forms across many countries' care standards, require the facility to provide necessary care and services to ensure a resident's abilities in activities of daily living do not diminish unless the individual's clinical condition demonstrates the diminution was unavoidable.
| Standard 3.1 · Standard 3: Personal Care & Daily Living Guidance & Learning |
GUIDANCE ASF-LTC-STD3-v3.0 |
| WHY THIS STANDARD EXISTS |
A resident who loses functional ability because staff did tasks for them rather than supporting them to do it themselves has experienced a genuinely preventable decline — the difference between assisting a resident to maintain their own ability and simply doing the task faster without them is exactly the difference this criterion exists to protect.
| WHAT GOOD LOOKS LIKE ✓ ADL support genuinely maintains resident capability, not just completes tasks. ✓ Any decline is tied to a specific, documented, unavoidable clinical cause. ✓ Care plans are genuinely reviewed and adjusted as ability changes. |
WHAT FAILURE LOOKS LIKE ✗ Staff routinely complete ADL tasks for residents who could do them with support. ✗ Decline is assumed as normal aging without specific clinical justification. ✗ Care plans remain static despite genuine changes in resident ability. |
| MOST COMMON REASONS FACILITIES SCORE PARTIAL |
1 Ability-maintaining support happens during less busy periods but tasks are completed directly when time is short.
Genuine support needs to hold up under real time pressure, not only when convenient.
2 Decline is documented but the specific clinical cause isn't always clearly identified.
A vague justification is difficult to distinguish from decline that was actually preventable.
3 Care plans are reviewed on schedule but don't consistently reflect genuine changes in resident ability.
A scheduled review that doesn't produce real adjustment doesn't provide the ongoing responsiveness this requires.
| HOW TO IMPLEMENT IF YOU ARE STARTING FROM ZERO |
Week 1 Observe current ADL support practice for genuine ability-maintaining approach.
Week 2 Train staff specifically on supporting rather than replacing resident capability.
Week 3 Establish specific clinical documentation requirements for any ADL decline.
Ongoing Review and adjust ADL care plans as resident ability genuinely changes.
| FOR SURVEYORS — WHAT IS NOT OBVIOUS |
Observe an actual ADL assistance interaction, particularly during a busy period.
This is where the real difference between support and task completion is most visible.
Ask for a specific example of documented decline and its clinical justification.
A real, specific example reveals whether justification is genuine, not just assumed.
| E-LEARNING academy.gmj.ge/ltc-std3-1-adl-support — 30 min · complete before self-assessment |
| Standard 3.2 NON-NEGOTIABLE · Standard 3: Personal Care & Daily Living Nutrition and Hydration Are Individualized and Actively Monitored |
ASSESSMENT ASF-LTC-STD3-v3.0 |
| CR ADAPTED | TR FULL | SM FULL | ST FULL |
| 3.2 NON-NEGOTIABLE L1 |
THE STANDARD Nutrition and Hydration Are Individualized and Actively Monitored Every resident receives a nourishing diet meeting their individual nutritional and special dietary needs, with hydration and eating assistance actively provided as needed — not a standardized menu applied uniformly regardless of individual requirements. |
| FACILITY SELF-ASSESSMENT Tick YES, PARTIAL, or NO for each question. |
| 1 | Does every resident's diet reflect their individual nutritional and special dietary needs, not a uniform standard menu? Genuine individualization, not a single menu applied regardless of individual requirements. Doc: Individual nutrition plan documentation |
YES | PARTIAL | NO |
| 2 | Is assistance with eating and drinking actively provided to residents who need it, not left for the resident to manage alone? Real, active assistance, not passive availability of food and drink alone. Doc: N/A — tested directly |
YES | PARTIAL | NO |
| 3 | Is a qualified dietitian or nutrition professional genuinely involved in developing individual nutrition plans? Genuine professional involvement, not a generic plan without individual clinical input. Doc: Dietitian involvement record |
YES | PARTIAL | NO |
ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.
| WHAT THE ASSESSOR DOES ON SITE no surprises, no hidden checks |
| DOCUMENT Individual nutrition plan review |
Reviews nutrition plans for a sample of residents for genuine individualization. |
| OBSERVE Eating and drinking assistance observation |
Observes an actual mealtime for genuine, active assistance to residents who need it. |
| DOCUMENT Dietitian involvement review |
Reviews evidence of genuine dietitian or nutrition professional involvement in individual plans. |
REFERENCES
- [12] Established long-term care regulatory principles, recognized in various forms across many countries' care standards, require the facility to provide each resident a nourishing, palatable, well-balanced diet meeting individual nutritional and special dietary needs, with assistance provided as needed.
| Standard 3.2 · Standard 3: Personal Care & Daily Living Guidance & Learning |
GUIDANCE ASF-LTC-STD3-v3.0 |
| WHY THIS STANDARD EXISTS |
Malnutrition and dehydration are genuinely serious, well-documented risks in long-term care specifically, and a resident who needs assistance eating or drinking, or who has specific dietary requirements, faces real harm if a standardized approach doesn't account for their actual individual needs.
| WHAT GOOD LOOKS LIKE ✓ Every resident's diet genuinely reflects their individual needs. ✓ Eating and drinking assistance is actively provided to residents who need it. ✓ A qualified dietitian is genuinely involved in individual nutrition planning. |
WHAT FAILURE LOOKS LIKE ✗ A standardized menu is applied regardless of individual dietary needs. ✗ Residents needing assistance are left to manage eating or drinking alone. ✗ Nutrition plans lack genuine professional dietitian involvement. |
| MOST COMMON REASONS FACILITIES SCORE PARTIAL |
1 Special dietary needs are accommodated for major conditions but not consistently for less common ones.
Every documented dietary need carries real risk if genuinely unaddressed, not only the most common ones.
2 Assistance is provided but rushed during busy mealtime periods.
Rushed assistance can result in inadequate intake even when technically provided.
3 Dietitian involvement happens at initial assessment but isn't revisited as a resident's condition changes.
Nutritional needs can change meaningfully over a long-term stay, and planning needs to reflect that.
| HOW TO IMPLEMENT IF YOU ARE STARTING FROM ZERO |
Week 1 Review current nutrition planning for genuine individualization versus standardized menus.
Week 2 Strengthen dietitian involvement in individual nutrition plan development.
Week 3 Observe and address mealtime assistance practice, particularly during busy periods.
Ongoing Revisit nutrition plans as resident condition changes.
| FOR SURVEYORS — WHAT IS NOT OBVIOUS |
Observe an actual mealtime, particularly for residents who need eating assistance.
Direct observation reveals whether assistance is genuine and adequate, not rushed or assumed.
Ask how a specific resident's special dietary need is actually accommodated in practice.
A specific, real answer reveals genuine individualization, not policy language alone.
| E-LEARNING academy.gmj.ge/ltc-std3-2-nutrition-hydration — 30 min · complete before self-assessment |
| Standard 3.3 NON-NEGOTIABLE · Standard 3: Personal Care & Daily Living Weight Loss Is Caught Early, Using a Specific Threshold |
ASSESSMENT ASF-LTC-STD3-v3.0 |
| CR ADAPTED | TR FULL | SM FULL | ST FULL |
| 3.3 NON-NEGOTIABLE L1 |
THE STANDARD Weight Loss Is Caught Early, Using a Specific Threshold Resident weight is monitored on a defined schedule, with a specific, recognised threshold for significant weight loss triggering immediate clinical review — not weight changes noticed informally or only after they become visually apparent. |
| FACILITY SELF-ASSESSMENT Tick YES, PARTIAL, or NO for each question. |
| 1 | Is resident weight monitored on a defined, regular schedule, not informally or irregularly? A specific, scheduled monitoring interval, not ad hoc weighing. Doc: Weight monitoring schedule and record |
YES | PARTIAL | NO |
| 2 | Does the specific 5% in 30 days or 10% in 180 days threshold trigger immediate clinical review? A specific, recognised threshold, not a vague sense that weight loss seems concerning. Doc: Significant weight loss response record |
YES | PARTIAL | NO |
| 3 | Once significant weight loss is identified, does monitoring frequency genuinely increase? Real, increased monitoring, not the same schedule continued regardless. Doc: N/A — tested directly |
YES | PARTIAL | NO |
ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.
| WHAT THE ASSESSOR DOES ON SITE no surprises, no hidden checks |
| DOCUMENT Monitoring schedule review |
Reviews the weight monitoring schedule and actual adherence to it. |
| DOCUMENT Threshold response review |
Reviews records for genuine, immediate clinical review when the significant weight loss threshold is met. |
| DOCUMENT Increased monitoring review |
Reviews whether monitoring frequency genuinely increases after significant weight loss is identified. |
REFERENCES
- [13] Established long-term care clinical practice recognizes significant unintended weight loss — commonly defined as approximately 5 percent in 30 days or 10 percent in 180 days — as a threshold requiring active identification, response, and increased monitoring frequency once loss is identified.
| Standard 3.3 · Standard 3: Personal Care & Daily Living Guidance & Learning |
GUIDANCE ASF-LTC-STD3-v3.0 |
| WHY THIS STANDARD EXISTS |
Significant, unintended weight loss is a genuinely serious warning sign in long-term care, often reflecting an underlying problem that hasn't yet been identified any other way, and catching it early through defined, scheduled monitoring against a specific threshold is measurably more reliable than waiting for it to become visually obvious.
| WHAT GOOD LOOKS LIKE ✓ Weight is monitored on a defined, consistently followed schedule. ✓ The specific threshold reliably triggers immediate clinical review. ✓ Monitoring frequency genuinely increases once significant loss is identified. |
WHAT FAILURE LOOKS LIKE ✗ Weight monitoring is irregular or informal. ✗ The threshold, even when met, doesn't reliably trigger review. ✗ Monitoring frequency doesn't change after significant weight loss is identified. |
| MOST COMMON REASONS FACILITIES SCORE PARTIAL |
1 Monthly weighing happens consistently but the specific percentage calculation isn't always performed.
Recording weight without calculating against the specific threshold misses the actual early-warning value.
2 Clinical review happens for weight loss but not consistently within a genuinely prompt timeframe.
The protective value of early identification depends on genuinely prompt follow-up, not eventual review.
3 Increased monitoring is ordered but not consistently followed through in practice.
An ordered change that isn't genuinely implemented doesn't provide real additional protection.
| HOW TO IMPLEMENT IF YOU ARE STARTING FROM ZERO |
Week 1 Review current weight monitoring schedule and threshold calculation practice.
Week 2 Establish consistent, systematic threshold calculation against the specific benchmark.
Week 3 Establish a defined, prompt clinical review process triggered by the threshold.
Ongoing Audit monitoring frequency increases following identified significant weight loss.
| FOR SURVEYORS — WHAT IS NOT OBVIOUS |
Ask for a specific, real example of significant weight loss and the resulting clinical response.
A real example reveals whether the threshold genuinely triggers action, not just gets recorded.
Check whether the specific percentage calculation is actually performed, not just weight recorded.
This is the precise mechanism that makes early identification possible.
| E-LEARNING academy.gmj.ge/ltc-std3-3-weight-loss-monitoring — 30 min · complete before self-assessment |
| Standard 3.4 CORE · Standard 3: Personal Care & Daily Living Food and Activities Reflect Genuine Cultural and Personal Preference |
ASSESSMENT ASF-LTC-STD3-v3.0 |
| CR N/A | TR FULL | SM ADAPTED | ST FULL |
| 3.4 CORE L1 |
THE STANDARD Food and Activities Reflect Genuine Cultural and Personal Preference Food and activities genuinely reflect each resident's cultural, religious, and personal preferences — with documented, active effort to learn these preferences even from a resident with dementia or communication barriers, not a standardized program applied uniformly regardless of individual background. |
| FACILITY SELF-ASSESSMENT Tick YES, PARTIAL, or NO for each question. |
| 1 | Do food and activities genuinely reflect individual residents' cultural, religious, and personal preferences? Genuine, individual reflection, not a standardized program applied uniformly. Doc: Preference accommodation documentation |
YES | PARTIAL | NO |
| 2 | For residents with dementia or communication barriers, is there documented, active effort to learn their preferences? Specific, documented effort, not an assumption that preferences can't be learned. Doc: Preference-learning documentation for residents with communication barriers |
YES | PARTIAL | NO |
| 3 | Are learned preferences actually reflected in what's provided, not just recorded without follow-through? Genuine follow-through, not preferences noted but not actually acted on. Doc: N/A — tested directly |
YES | PARTIAL | NO |
ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Requires improvement plan.
| WHAT THE ASSESSOR DOES ON SITE no surprises, no hidden checks |
| DOCUMENT Preference accommodation review |
Reviews evidence that food and activities genuinely reflect individual resident preferences. |
| DOCUMENT Communication barrier effort review |
Reviews documented effort to learn preferences from residents with dementia or communication barriers. |
| OBSERVE Follow-through observation |
Checks whether documented preferences are genuinely reflected in what's actually provided. |
REFERENCES
- [14] The United Nations Principles for Older Persons establish that older persons should be able to live in environments adaptable to personal preferences, a principle reflected in established long-term care practice as the facility's responsibility to make reasonable efforts to learn and accommodate each resident's cultural and personal food preferences, including documented steps to learn preferences from residents facing barriers to expressing them directly.
| Standard 3.4 · Standard 3: Personal Care & Daily Living Guidance & Learning |
GUIDANCE ASF-LTC-STD3-v3.0 |
| WHY THIS STANDARD EXISTS |
For a resident living in a facility long-term, food and activities are not incidental — they are a significant part of daily quality of life, and a program that ignores genuine cultural and personal preference treats residents as an undifferentiated group rather than the individuals they are, even when their ability to directly express that preference is affected by dementia or communication barriers.
| WHAT GOOD LOOKS LIKE ✓ Food and activities genuinely reflect individual cultural, religious, and personal preferences. ✓ Active, documented effort exists to learn preferences from residents with communication barriers. ✓ Learned preferences are genuinely reflected in practice, not just recorded. |
WHAT FAILURE LOOKS LIKE ✗ A standardized program is applied uniformly regardless of individual background. ✗ No documented effort exists to learn preferences from residents with communication barriers. ✗ Preferences are recorded but not genuinely acted on. |
| MOST COMMON REASONS FACILITIES SCORE PARTIAL |
1 Major religious dietary requirements are accommodated but more individual personal preferences are not.
Personal, non-religious preferences still carry real meaning for a resident's daily quality of life.
2 Effort to learn preferences happens at admission but isn't revisited as dementia progresses and communication changes.
A resident's ability to express preference, and preferences themselves, can genuinely change over time.
3 Preferences are documented but the connection between documentation and actual daily provision is inconsistent.
Documentation without genuine operational follow-through doesn't provide the real benefit this criterion exists to ensure.
| HOW TO IMPLEMENT IF YOU ARE STARTING FROM ZERO |
Week 1 Review current preference accommodation for genuine individualization versus standardized programming.
Week 2 Establish a specific, documented process for learning preferences from residents with communication barriers.
Week 3 Build a clear connection between documented preferences and actual daily food and activity provision.
Ongoing Revisit preference documentation as residents' communication ability changes.
| FOR SURVEYORS — WHAT IS NOT OBVIOUS |
Ask staff how they learned a specific resident's preferences, particularly one with dementia.
A specific, real example reveals genuine effort, not an assumption preferences can't be learned.
Compare documented preferences against what's actually provided to a specific resident.
This reveals whether documentation translates into genuine practice.
| E-LEARNING academy.gmj.ge/ltc-std3-4-cultural-preference — 30 min · complete before self-assessment |
| Standard 3.5 CORE · Standard 3: Personal Care & Daily Living A Qualified Activities Program Provides Genuine Social Engagement |
ASSESSMENT ASF-LTC-STD3-v3.0 |
| CR N/A | TR FULL | SM ADAPTED | ST FULL |
| 3.5 CORE L1 |
THE STANDARD A Qualified Activities Program Provides Genuine Social Engagement The facility provides an ongoing activities program led by a genuinely qualified activities professional, offering real, varied social and recreational engagement — not passive entertainment like a television left on, or a program that exists on paper without genuine resident participation. |
| FACILITY SELF-ASSESSMENT Tick YES, PARTIAL, or NO for each question. |
| 1 | Is the activities program led by a genuinely qualified activities professional meeting defined qualification criteria? Specific, verified qualification, not simply a staff member assigned the role informally. Doc: Activities professional qualification record |
YES | PARTIAL | NO |
| 2 | Does the program offer real, varied engagement matched to individual resident interests, not passive entertainment alone? Genuine variety and individual relevance, not a single default activity like television. Doc: Activities program schedule and content |
YES | PARTIAL | NO |
| 3 | Is genuine resident participation observed, not just a program that exists on paper? Real, observed participation, not activities offered without residents actually engaging. Doc: N/A — tested directly |
YES | PARTIAL | NO |
ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Requires improvement plan.
| WHAT THE ASSESSOR DOES ON SITE no surprises, no hidden checks |
| DOCUMENT Activities professional qualification review |
Reviews the qualification of the person leading the activities program against defined criteria. |
| DOCUMENT Program content review |
Reviews the activities program schedule for genuine variety matched to resident interests. |
| OBSERVE Participation observation |
Observes an actual activity for genuine resident participation, not passive presence alone. |
REFERENCES
- [15] The United Nations Principles for Older Persons establish that older persons should be able to pursue opportunities for the full development of their potential and remain integrated in society, a principle reflected in established long-term care practice as requiring an ongoing activities program directed by a qualified activities professional to meet the interests and support the physical, mental, and psychosocial well-being of each resident.
| Standard 3.5 · Standard 3: Personal Care & Daily Living Guidance & Learning |
GUIDANCE ASF-LTC-STD3-v3.0 |
| WHY THIS STANDARD EXISTS |
Social isolation and lack of meaningful engagement carry real, documented harm to a long-term resident's psychological wellbeing, and a facility that provides only passive entertainment, or an activities program that exists in name only, is failing a genuine, significant part of what quality of life means for someone living there long-term.
| WHAT GOOD LOOKS LIKE ✓ The activities program is led by a genuinely, verifiably qualified professional. ✓ The program offers real, varied engagement matched to individual interests. ✓ Genuine resident participation is observed, not just programmed availability. |
WHAT FAILURE LOOKS LIKE ✗ The activities role is filled informally without meeting defined qualification criteria. ✗ The program defaults to passive entertainment with little genuine variety. ✗ Activities exist on the schedule but residents don't genuinely participate. |
| MOST COMMON REASONS FACILITIES SCORE PARTIAL |
1 The activities professional is qualified but the program isn't adapted for residents with significant cognitive impairment.
Meaningful engagement needs to be genuinely accessible to residents across the full range of cognitive ability.
2 Variety exists on the schedule but actual attendance is concentrated in a small group of residents.
A program's real value depends on genuinely reaching residents broadly, not just being available.
3 Group activities are offered but residents who prefer individual engagement have fewer genuine options.
Meaningful engagement looks different for different residents, and a program should genuinely reflect that.
| HOW TO IMPLEMENT IF YOU ARE STARTING FROM ZERO |
Week 1 Review activities professional qualification against defined criteria.
Week 2 Assess program variety and adaptation for residents with cognitive impairment.
Week 3 Establish tracking of genuine resident participation, not just program offerings.
Ongoing Review participation patterns and adjust programming to reach residents more broadly.
| FOR SURVEYORS — WHAT IS NOT OBVIOUS |
Observe an actual activity session directly, watching for genuine participation, not passive presence.
Direct observation reveals whether engagement is real, not just scheduled.
Ask to see the activities professional's specific qualification credentials.
Specific, verifiable credentials are the real evidence of genuine qualification, not an assumed title.
| E-LEARNING academy.gmj.ge/ltc-std3-5-activities-program — 30 min · complete before self-assessment |
Long-Term Care Standards — overviewFacility Classification — Which Type of Facility Are You?Standard 1 — Admission & Resident RightsStandard 2 — Living Environment & SafetyStandard 3 — Personal Care & Daily LivingStandard 4 — Clinical & Medical CareStandard 5 — Cognitive & Behavioral CareStandard 6 — End-of-Life & Palliative CareStandard 7 — Governance & StaffingStandard 8 — Medical TourismStandard 9 — Health & MigrationReferences & Index
STANDARD 3Personal Care & Daily Living3.1 Activities of Daily Living Support Prevents Unnecessary Decline3.2 Nutrition and Hydration Are Individualized and Actively Monitored3.3 Weight Loss Is Caught Early, Using a Specific Threshold3.4 Food and Activities Reflect Genuine Cultural and Personal Preference3.5 A Qualified Activities Program Provides Genuine Social Engagement
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