Health & Migration

Requires Standards 1–7 verified first

10 criteria

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [46] WHO Competency Standard 1 (Refugee and Migrant Health: Global Competency Standards for Health Workers, 2021) requires health workers to adapt practice to migration and displacement experiences, address trauma-informed care and psychosocial needs, and support continuity of care regardless of legal status.

A refugee or migrant resident's health needs and vulnerabilities are shaped by what happened before they ever arrived at this facility — in their country of origin, in transit, and on arrival — and for a resident who will live here for years, care that ignores this context misses real, clinically relevant information and can retraumatise someone who has already experienced significant hardship.

1 Adaptation happens for residents who disclose their history but isn't proactively considered otherwise.

Not every resident will volunteer this history unprompted, even when it is clinically relevant.

2 Staff are aware of the principle but haven't received specific training on applying it.

General awareness doesn't reliably translate into genuine practice adaptation without specific training.

3 Adaptation is strong at admission but isn't sustained as staff turn over during a resident's long-term stay.

A years-long residency depends on this understanding genuinely persisting through staff changes, not fading over time.

Week 1 Review current practice for genuine adaptation to migration and displacement history.

Week 2 Train staff specifically on trauma-informed, migration-adapted practice.

Week 3 Build awareness of legal-status access barriers into standard practice.

Ongoing Ensure new staff are briefed on a resident's migration history as part of onboarding to their care.

Ask staff to describe a specific example of adapting care for a resident's migration history.

A real, specific example reveals genuine practice, not familiarity with the principle.

Ask a newer staff member how they learned about a specific resident's migration background.

This reveals whether this understanding genuinely persists through staff turnover.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [47] WHO Competency Standards 2 and 4 (Refugee and Migrant Health: Global Competency Standards for Health Workers, 2021) require health workers to assess and support health system literacy as distinct from condition-specific understanding, and to actively verify genuine understanding through methods such as teach-back rather than assuming comprehension from silence.

For a refugee or migrant resident, understanding an unfamiliar long-term care facility and system can matter as much for genuine quality of life as any single care decision, and a resident who nods along without genuinely understanding — particularly through the added layer of interpretation — can live for years with a dangerously incomplete picture of their own care and rights.

1 Teach-back is used for major care decisions but not extended to facility-navigation information.

Understanding how to actually live within the facility matters as much as understanding the immediate care plan.

2 Navigation support is given verbally at admission but not reinforced with anything the resident can review later.

Complex facility information delivered once, verbally, under stress is easily forgotten, especially over a long residency.

3 Staff assume understanding for residents who have lived at the facility longer, missing gaps that may still exist.

Length of residency does not reliably correlate with genuine understanding.

Week 1 Observe current practice for both understanding-verification and facility-navigation support.

Week 2 Train staff on teach-back technique and develop translated navigation guidance.

Week 3 Brief staff to proactively cover facility navigation alongside the immediate care matter.

Ongoing Spot-check resident understanding of both care and navigation periodically throughout their stay.

Observe an actual care conversation, watching specifically for teach-back covering both care and navigation.

This is a practice that is easy to describe in policy and easy to skip under time pressure.

Ask a longer-term resident directly what they understand about raising a concern.

This tests actual understanding sustained over time, not just satisfaction with an early conversation.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [48] WHO Competency Standard 3 explicitly states health workers have a responsibility not to engage minors to facilitate interpretation, given the associated significant risk, and identifies inaccuracy, information distortion, and compromised confidentiality as documented risks of family-member interpretation generally.

Family members interpreting, especially minors, carries real, well-documented risks — inaccurate interpretation, withheld or distorted information, compromised confidentiality, and trauma to the family member themselves. For a resident living here long-term, this isn't a single admission-day requirement but an ongoing need for the duration of their residency.

1 Trained interpreters are used at admission but family members fill in for routine, ongoing conversations.

Ongoing care over a long residency carries the same real risk as the initial admission conversation.

2 The no-minors rule is understood by senior staff but not consistently reinforced with newer or part-time staff.

A critical safeguard needs to be embedded in onboarding, not assumed as common knowledge.

3 Interpreter access exists during clinic hours but reverts to family members for urgent or after-hours situations.

Coverage gaps at specific times undermine an otherwise sound policy.

Week 1 Review recent language-discordant care for interpreter engagement patterns across the full residency, not just admission.

Week 2 Establish or reinforce trained interpreter access, including for urgent and after-hours situations.

Week 3 Brief all staff explicitly and unambiguously that minors are never used to interpret.

Ongoing Audit family-member interpretation instances to confirm they're confined to genuinely low-risk situations.

Ask the minor-interpreter question directly and expect an immediate, confident answer.

Any hesitation on this specific point is a serious signal worth investigating further.

Check interpreter coverage specifically for urgent or after-hours situations.

This is where the policy is most likely to quietly lapse.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Requires improvement plan.

REFERENCES

1. [49] WHO Competency Standard 5 requires engagement with broader social and community support services and effective handover of care that specifically includes cultural, language, and migration- and displacement-related considerations.

Legal status, community connection, and social support don't just sit alongside a refugee or migrant resident's wellbeing — they actively shape it, and a facility that treats care in isolation from these factors, or that fails to hand over migration-related context to another provider, misses information a purely clinical view wouldn't capture.

1 Engagement happens with legal services but not consistently with broader community support.

Each of these factors can independently and significantly affect a resident's wellbeing.

2 Handover includes clinical information but omits migration-related context that shaped the resident's care.

3 Staff know general categories of support exist but not specific, current local contacts.

Specific, current knowledge is what makes a referral actually actionable.

Week 1 Map current engagement with relevant legal and social support services.

Week 2 Establish or strengthen specific, current local service contacts.

Week 3 Build migration-related context into standard handover documentation.

Ongoing Refresh knowledge of local services periodically as availability changes.

Ask staff to name a specific local service they would refer a resident's family to, not a general category.

Specificity reveals genuine, current knowledge rather than assumed awareness.

Review a real handover document for migration-related context inclusion.

A real example reveals whether this happens in practice, not just in policy.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [50] Nygren B, Hydén LC. Caring for older people with dementia reliving past trauma. Nurs Ethics. 2020;27(2):621-633 — documents that the onset of dementia can trigger the re-emergence of traumatic stress symptoms dormant for decades among genocide and violence survivors, and establishes that knowledge of a resident's life story enables staff to adapt care and avoid retraumatising triggers.

For a refugee resident who survived violence, displacement, or genocide, dementia can genuinely bring long-dormant trauma back to the surface — a documented phenomenon distinct from typical dementia-related behavioral change — and staff who don't recognise this risk responding to a genuine trauma re-emergence as if it were simply confusion or aggression, missing what the resident is actually experiencing.

1 Staff recognise the general concept but don't consistently apply it to specific behavioral episodes.

General awareness needs to translate into genuine, individual application during real moments of distress.

2 Life history is documented but not actively referenced during care planning or in-the-moment response.

Documented history that isn't genuinely used provides limited real protective value.

3 Awareness is strong among nursing staff but not consistently shared with support staff providing daily personal care.

Personal care moments are often exactly where retraumatising triggers occur, and support staff need the same awareness.

Week 1 Review current staff awareness of trauma re-emergence as distinct from general dementia behavior.

Week 2 Train staff specifically on this documented phenomenon and how life history informs response.

Week 3 Review standard care practices for individual retraumatising potential for residents with known trauma history.

Ongoing Revisit trauma-informed care planning as a resident's dementia progresses.

Ask staff to describe a specific example of connecting a resident's life history to a behavioral episode.

A real, specific example reveals genuine understanding, not familiarity with the general concept.

Ask how personal care practices, like bathing assistance, have been adapted for a resident with known trauma history.

This tests whether the principle translates into genuine, practical care adaptation.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Requires improvement plan.

REFERENCES

1. [51] WHO Competency Standard 7 requires health workers to use evidence-informed guidelines specific to refugee and migrant health where they exist, recognise where the health needs of this population differ from the general population, and identify where evidence gaps remain.

Refugee and migrant elders carry a genuinely different risk profile than the general elderly population — elevated rates of uncontrolled chronic conditions, PTSD, and depression, all independently linked to cognitive decline — and care that ignores this and applies general geriatric guidelines uncritically can miss real, evidence-based adjustments this specific population needs.

1 Awareness exists for well-known differences but not for more specific or recent evidence.

Evidence in this area continues to develop, and awareness needs to stay genuinely current.

2 Guidelines are known but not consistently applied under time pressure.

Consistent application under real conditions is what gives awareness genuine protective value.

3 Evidence gaps are acknowledged but staff default to general population assumptions rather than flagging genuine uncertainty.

Recognising a genuine gap honestly is different from silently defaulting to a possibly inapplicable assumption.

Week 1 Review current awareness of population-specific evidence-informed guidelines.

Week 2 Establish access to current, relevant guidelines for staff.

Week 3 Train staff on specific, genuine population differences relevant to practice.

Ongoing Refresh awareness as evidence in this area develops.

Ask staff for a specific example of a practice adaptation based on population-specific evidence.

A real example reveals genuine application, not just familiarity with the concept.

Ask how staff would handle a genuine evidence gap for this population.

A thoughtful, honest answer reveals genuine engagement rather than a default assumption.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [52] WHO Competency Standards 8 and 9 (Refugee and Migrant Health: Global Competency Standards for Health Workers, 2021) require health workers to maintain structured awareness of their own biases and institutional discrimination's impact, and to engage in self-care within a supportive team environment addressing the wellbeing impacts of migration-context care.

Unacknowledged bias shapes care judgement in ways that are genuinely hard to see from the inside, and staff providing long-term, intimate care to residents with severe trauma histories are regularly exposed to real, accumulating emotional weight — both require structured, deliberate support rather than being left to individual capacity alone.

1 Reflective practice happens informally among some staff but is not structured or facility-wide.

Individual good practice does not reliably generalise without a defined, shared process.

2 Support exists but staff are unaware it is available or feel discouraged from using it.

A benefit's existence does not guarantee genuine, comfortable access to it.

3 Support exists for acute incidents but not for the cumulative emotional weight of long-term care for trauma survivors.

This is ongoing, long-term work, and cumulative emotional impact deserves the same genuine support as acute incidents.

Week 1 Review current training content and support access for genuine coverage of bias and staff wellbeing.

Week 2 Establish a structured reflective practice process and strengthen support access.

Week 3 Deliver specific training on institutional discrimination and normalise use of available psychological support.

Ongoing Revisit reflective practice and staff wellbeing periodically, using real case examples where appropriate.

Ask for a specific personal example, not a general statement of awareness.

A concrete instance distinguishes genuine reflective practice from familiarity with the concept.

Ask staff directly whether they have used available support, not just whether it exists.

Genuine uptake, not nominal availability, is the real test.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Requires improvement plan.

REFERENCES

1. [53] WHO's Competency Standards explicitly distinguish these legal status categories throughout, noting that access to health care and legal entitlements vary meaningfully by status and by country, and that health workers need specific awareness of this rather than a single generalised assumption.

Asylum seeker, recognised refugee, and stateless person are not interchangeable categories — they carry genuinely different legal rights and, for a long-term resident, genuinely different implications for future planning, including where end-of-life documentation and decisions will ultimately be recognised.

1 Staff can name the most common category served but not less frequent ones the facility still encounters.

Even infrequent categories deserve genuine, specific awareness, not the risk of misapplied assumptions.

2 Differentiation exists in policy but isn't consistently applied by all staff in practice.

A policy that exists on paper needs consistent application to provide real protection.

3 Status is understood for care access but not connected to longer-term planning implications.

Legal status can genuinely affect future planning, not only immediate access to care.

Week 1 Review current staff awareness of the specific legal status categories actually served.

Week 2 Build specific, differentiated guidance for each relevant status category, including planning implications.

Week 3 Establish a clear verification process for genuinely unclear status.

Ongoing Refresh staff awareness periodically, particularly for less frequently encountered categories.

Ask staff to name every specific legal status category the facility has served recently.

Specificity reveals genuine, current awareness rather than a general assumption.

Ask what happens when a resident's specific status is genuinely unclear.

A confident, specific answer reveals a genuine process, not improvisation.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [54] Genuine exploration of culturally and religiously appropriate end-of-life alternatives for residents unable to return to their country of origin, distinct from default application of local custom, is established practice in refugee and displaced-population end-of-life care literature.

For many refugees, the country they fled is not a place they can return to even after death — due to ongoing conflict, statelessness, or the same danger that caused their displacement in the first place — and a resident facing this reality deserves a genuine, proactive conversation about meaningful alternatives, not silence on a painful reality or a default to unfamiliar local custom.

1 The conversation happens but relies on the resident to raise it themselves rather than being proactively offered.

A resident may not know to ask, or may find it too painful to raise unprompted, without the facility proactively offering the conversation.

2 Community connection is attempted but not genuinely pursued if initial contact doesn't succeed.

A meaningful connection may take real, sustained effort to establish, not a single attempted contact.

3 Planning happens for the resident but doesn't specifically involve family members who may also be displaced across multiple countries.

Family involvement in this planning may itself require genuine cross-border coordination for a displaced family.

Week 1 Review current end-of-life planning practice for residents unable to return to their country of origin.

Week 2 Build genuine, proactive practice for exploring culturally appropriate alternatives.

Week 3 Establish a genuine effort process for connecting with relevant diaspora or faith communities.

Ongoing Revisit this planning as a resident's circumstances or wishes may change.

Ask staff for a real, specific example of this conversation and what alternatives were genuinely explored.

A real example reveals whether this is genuine practice, not just policy language.

Ask how the facility would help connect a resident with a relevant community if none is already known.

A specific, thoughtful answer reveals genuine, active effort, not passive assumption.

ALL YES Standard likely met. ANY PARTIAL Improvement plan required. ANY NO Blocks accreditation until resolved.

REFERENCES

1. [55] Equal standard of care and documentation regardless of immigration or legal status, without differential record-keeping practice, is established practice in international guidance on healthcare access for migrant and refugee populations.

A family placing a relative who fears that seeking care will expose immigration status to consequences may delay or avoid care entirely, and any indication that this facility applies a different standard based on status only reinforces that fear — genuine equal treatment, documented the same way for everyone, is what makes long-term care genuinely accessible to this population.

1 The principle is understood by clinical staff but not consistently by administrative staff.

A resident's first interaction is often with administrative staff, where the same principle needs to hold.

2 Care is consistent but documentation habits vary informally based on individual staff assumptions.

Consistency needs to extend to documentation practice specifically, not only the clinical care itself.

3 The principle is followed but has never been specifically, formally trained.

Informal understanding is less reliable than specific, documented training, particularly as staff turn over.

Week 1 Review current practice for any differential treatment based on status.

Week 2 Establish specific staff training on this principle, covering all staff, not only clinical roles.

Week 3 Confirm documentation practice is genuinely consistent regardless of status.

Ongoing Reinforce training periodically, particularly for new staff.

Ask administrative staff, not only clinicians, about this principle.

This reveals whether the principle genuinely extends beyond clinical staff.

Ask how resident status information, where it becomes known, is protected.

A specific, confident answer reveals genuine practice, not just a stated value.