Aboriginal or Torres Strait Islander
A person of Aboriginal and/or Torres Strait Islander descent who identifies as an Aboriginal and/or Torres Strait Islander.[1]
Activities of daily living
Activities of daily living include the fundamental skills typically needed to manage basic physical needs in the following areas: grooming/personal hygiene including oral care, dressing, toileting/continence, transferring/ambulating, and eating.[1]
Advance care documents
A catch-all term to include documents that result from advance care planning. It includes Advance Care Directives and Advance Care Plans.
An Advance Care Directive is a document completed and signed by a competent older person who still has decision-making capacity regarding their future care and preferences for end of life care. In Australia, advance care directives are recognised by specific legislation or common law. Advance care directives can record the person’s preferences for future care and/or appoint a substitute decision-maker to make decisions about the person’s health care. An advance care plan captures what is known about a person’s beliefs, values and preferences in relation to future care decisions, but it does not meet the requirements for statutory or common law recognition as a result of the person’s insufficient capacity. The document may provide helpful information to guide substitute decision-makers and health professionals but is not legally binding.[1]
Advance care planning
The voluntary process of planning for future health and personal care needs. It provides a way for an older person to make their beliefs, values and preferences for future medical care known to inform future medical decisions, if the older person cannot make or communicate these decisions themselves. Advance care planning is not a single event but an ongoing process and conversation that should be undertaken early and revisited regularly.[1]
Adverse event
An incident that results, or could have resulted, in harm to a resident or consumer. A near miss is a type of adverse event. (NSQPCH Standards 2021.)[1]
Advocate
An advocate is an impartial person who can support older people in a variety of situations – from understanding aged care services or fees through to understanding their rights and managing their aged care. The Australian Government offers free, independent, and confidential support through the National Aged Care Advocacy Program (NACAP). The program is delivered by the Older Persons Advocacy Network (OPAN).[1]
Aged Care Quality Standards
The rules may prescribe standards relating to the quality of funded aged care services delivered by a registered provider.[3]
Aged Care Worker of a registered provider means:
(a) an individual employed or otherwise engaged (including as a volunteer) by the registered provider; or
(b) an individual who:
(i) is employed or otherwise engaged (including as a volunteer) by an associated provider of the registered provider; and(ii) is engaging in conduct under the associated provider’s arrangement with the registered provider relating to the registered provider’s delivery of funded aged care services; or
(c) an individual who is a registered provider.
Note: An individual engaged by a registered provider includes an independent contractor.[3]
Aged care worker screening check
An assessment, under an aged care worker screening law, of whether a person who work, or seeks to work, with individuals accessing funded aged care services poses a risk to such individuals.[3]
Allied health assistant
A person who holds a Certificate IV in Allied Health Assistance from a registered training organisation within the meaning of the National Vocational Education and Training Regulator Act 2011.[2]
Allied health profession
A health profession other than the following:
(a) dental practitioner;
(b) medical practitioner;
(c) midwife;
(d) nurse.[2]
Allied health professional
A person who is registered under the National Law in an allied health profession.[2]
Approved provider
Means an approved provider within the meaning of the Commission Act as in force immediately before the commencement of this Act.[3]
Appointed decision maker
An older person may have someone who has guardianship, enduring power of attorney or similar legal authority for them. They can only make decisions on an older person’s behalf in line with their active, legal authority.[4]
Approved quality auditor
A person who:
(a) is approved by an entity of a kind prescribed by the rules; and
(b) meets any other training or qualification requirements prescribed by the rules.[2]
Approved residential care home
Means a residential care home that is:
(a) approved in relation to a registered provider under paragraph 112; or
(b) taken to be approved in relation to a registered provider.[3]
AT-HM List
The Assistive Technology and Home Modifications List published by the Department, as existing on [date of commencement of this instrument].[2]
Anticipatory medicines
Medicines prescribed and dispensed in preparation for a time when a person needs them. They are used to manage symptoms in the home with the goals of rapid relief and avoiding unplanned or unwarranted admission to a healthcare facility.[1]
Antimicrobials
A chemical substance that inhibits or destroys bacteria, viruses or fungi, and can be safely administered to humans and animals (NSQHS Standards, 2nd ed.).[1]
Antimicrobial stewardship
An ongoing effort by a provider to reduce the risks associated with increasing antimicrobial resistance and to extend the effectiveness of antimicrobial treatments. It can include a broad range of strategies, such as monitoring and reviewing how antimicrobials are used. (NSQHS Standards, 2nd ed.).[1]
Aseptic technique
A set of practices aimed at minimising contamination; particularly used to protect a person from infection during procedures (NSQPCH Standards 2021).[1]
Care Needs
Means one or both of the following apply in relation to an individual:
(a) the individual has difficulty (whether physical, mental or social) undertaking any daily living activities;
(b) the individual requires help from another person, or the assistance of one or more aids, to maintain their physical function independently.[3]
Care and services plan
A document (or set of documents) describing a person’s aged care and service needs, including clinical care they receive to meet those needs. Care and services plans include relevant information about a person’s needs, goals and preferences and describe how and when services are delivered in line with these.[1]
Carer
(a) provides personal care, support and assistance to another individual who needs it because that other individual is an older individual; and (b) does not provide the personal care, support and assistance to the individual:
(i) as an aged care worker of a registered provider; or
(ii) in the course of doing voluntary work for a charitable, welfare or community organisation, including as an aged care volunteer visitor; or
(iii) as part of the requirements of a course of education or training.[3]
Clinical care
Health care that encompasses the prevention, treatment and management of illness or injury, as well as the maintenance of psychosocial, mental and physical wellbeing. It includes care provided by doctors, nurses, pharmacists, allied health professionals and other regulated health professionals. Organisations providing clinical care are expected to make sure it is best practice, meets the older person’s needs, and optimises the older person’s health and wellbeing.[1]
Clinical frailty
Clinical frailty is a syndrome of physiological decline that occurs in later life and is associated with vulnerability to adverse health outcomes. Older people who are frail are less resilient to stressors (e.g. acute illness, trauma) and at an increased risk of adverse outcomes, procedural complications, falls, institutionalisation, disability and death. Old age alone does not define frailty, and frailty is not an inevitable consequence of ageing (RACGP Aged Care Clinical Guide (Silver Book) 5th edition).[1]
Clinical governance
An integrated set of leadership behaviours, policies, procedures, responsibilities, relationships, planning, monitoring and improvement mechanisms that are implemented to support safe, quality clinical care and good clinical outcomes for each older person. The purpose of clinical governance in aged care is to support the workforce and visiting health professionals in a service to provide safe, quality clinical care as part of a holistic approach to aged care that is based on the needs, goals and preferences of the older person.[1]
Clinical governance framework
The clinical governance framework provides a structure that ensures all who are involved in an older person’s care, including the older person, understand their roles and responsibilities. This includes members of governing bodies such as boards, senior executives, managers, health professionals, personal care staff and other staff who have an indirect role in providing care or services. All providers whose remit includes clinical care should demonstrate the use of a clinical governance framework. The clinical governance framework should include the core elements as described by the Aged Care Quality and Safety Commission (ACQSC):
A. Leadership and culture
B. Consumer partnerships
C. Organisational Systems
D. Monitoring and reporting
E. Effective workforce
F. Communication and relationships[1]
Clinical Information System
A system that is used by a healthcare or aged care provider to manage older person’s clinical information. It should ensure clinical information required for transfers of care, for health professionals or workers can be safely stored, accessed and updated in line with legislative requirements.[1]
Comprehensive care
Health care that is based on identified goals for the episode of care. These goals are aligned with the person’s expressed preferences and healthcare needs, consider the impact of the person’s health issues on their life and wellbeing, and are clinically appropriate. (NSQPCH Standards 2021).[1]
Continuous improvement plan
Means a plan in writing, which sets out:
(a) how a registered provider intends to improve the quality of funded aged care services delivered by the registered provider; and
(b) if the Commissioner imposed a condition on the registration of the registered provider under subsection 89(1) which relates to the quality of funded aged care services delivered by the registered provider – how the registered provider intends to comply with that condition.[3]
Culturally safe care
Culturally safe care and services are planned and delivered in a way that is spiritually, socially, emotionally and physically safe and respectful for older people. Culturally safe care and services ensure that an older person’s identity is respected so that who they are and what they need is not questioned or denied. Whether care and services are ‘culturally safe’ can only be determined by those receiving care. For Aboriginal and Torres Strait Islander peoples, culturally safe practice is the ongoing critical reflection on provider knowledge, skills, attitudes, practicing behaviours and power differentials in delivering safe, accessible and responsive care and services free of racism.[1]
Delirium
An acute disturbance of consciousness, attention, cognition and perception that tends to fluctuate during the day. It is a serious condition that can be prevented in 30–40% of cases and should be treated promptly and appropriately. Delirium can be hyperactive (the person has heightened arousal; or can be restless, agitated and aggressive) or hypoactive (the person is withdrawn, quiet and sleepy) (NSQHS Standards, 2nd ed.).[1]
Dementia
A collection of symptoms that are caused by disorders affecting the brain. It is not one specific disease. Dementia affects thinking, behaviour and the ability to perform everyday tasks. Brain function is affected enough to interfere with the person’s normal social or working life.[1]
Deprescribe
The process of tapering or stopping medicines, which aims to discontinue potentially inappropriate medicines, minimise inappropriate polypharmacy and improve a person’s health outcomes. Also referred to as ‘de-escalation’.[1]
Deterioration
Physiological, psychological or cognitive changes that may indicate a significant worsening of the older person’s health status (NSQPCH Standards 2021).[1]
Digital clinical information system
The software used by the provider to enter, store and retrieve an older person’s clinical information.[1]
Dignity of risk
The concept that all adults have the right to make decisions that affect their lives and to have those decisions respected, even if there is some risk to themselves.[1]
Diverse Cultural Activities
Includes cultural activities for the following:
(a) Aboriginal or Torres Strait Islander persons;
(b) individuals from culturally, ethnically and linguistically diverse backgrounds;
(c) individuals who are lesbian, gay, bisexual, trans/transgender or intersex or other sexual orientations, gender diverse or bodily diverse.[2]
Diversity
The varied needs, characteristics and life experiences, which may be social, cultural, linguistic, religious, spiritual, psychological, medical or care needs of older people. Also refers to diverse gender and sexuality identities, experiences and relationships, including (but not limited to) lesbian, gay, bisexual, transgender or intersex.[1 & 2]
End of life
The period when an older person is living with, and impaired by, a fatal condition, even if trajectory is ambiguous or unknown. This period may be years in the case of older people with chronic or malignant disease, or very brief in the case of older people who suffer acute and unexpected illnesses or events, such as sepsis, stroke or trauma (NSQHS Standards, 2nd ed).[1]
Goals of care
Clinical and other goals for an older person’s care that are determined in the context of a shared decision-making process (NSQHS Standards, 2nd ed.)[1]
Governance
The set of relationships and responsibilities established by an organisation between its executive, workforce and stakeholders (including the older person). Governance incorporates the processes, customs, policy directives, laws and conventions affecting the way an organisation is directed, administered or controlled. Governance arrangements provide the structure for setting the corporate objectives (social, fiscal, legal, human resources) of the organisation and the means to achieve the objectives. They also specify the mechanisms for monitoring performance. Effective governance provides a clear statement of individual accountabilities within the organisation to help align the roles, interests and actions of different participants in the organisation to achieve the organisation’s objectives. Governance includes both corporate and clinical governance. (NSQHS Standards, 2nd ed.).[1]
Governing body
The individual or group of people (such as a Board) with overall responsibility and ultimate accountability for the organisation. This includes responsibility for the strategic and operational decisions that affect the safety and quality of care and services.[1]
Health Identifiers (HIs)
Unique numbers assigned and used in health-related information to clearly identify the older person, the treating professional and the organisation where healthcare is provided. They reduce the potential for errors with healthcare related information and communication. In Australia, the Healthcare Identifiers (HI) Service is a national system for uniquely identifying, healthcare providers, healthcare and aged care organisations and individuals receiving healthcare.[1]
Health professionals
People who provide health care, treatment and advice based on formal training and experience. This includes nurses, doctors, dentists, specialists and allied health professionals.[1]
High-risk medicines
Medicines that have an increased risk of causing significant harm or death if they are misused or used in error. High-risk medicines may vary between hospitals and other settings, depending on the types of medicines used and person being treated. Errors with these medicines are not necessarily more common than with other medicines. Because they have a narrow margin of safety, the consequences of errors with high-risk medicines can be more significant.[1]
Holistic
A holistic approach means to provide support that looks at the whole person. In the provision of clinical care, the provider should consider the older person’s physical, mental and emotional, social and spiritual wellbeing (adapted from NSW Health definition).[1]
In a service group
A funded aged care service is in a service group if the service is in a service type that is in the service group.[2]
Incident
Any act, omission, event or circumstance that occurs in connection with the provision of care or services that:
- has (or could reasonably be expected to have) caused harm to an older person or another person (such as a worker or family member)
- is suspected or alleged to have (or could reasonably be expected to have) caused harm to an older person or another person, or
- the provider becomes aware of and has caused harm to an older person (NSQHS Standards, 2nd ed).[1]
Infection
The invasion and reproduction of pathogenic (disease-causing) organisms inside the body. This may cause tissue injury and disease (NSQHS Standards, 2nd ed.).[1]
Infection Prevention and Control
The system, plan and processes which an organisation uses to prevent and manage the spread of infection. The scope and complexity of a program will depend on the nature of the care the organisation provides, the context and risk. (ACQSC, Glossary)[1]
Informed consent
An older person’s decision, given voluntarily, to agree to a clinical care treatment, procedure or other intervention that is made:
- following the provision of accurate and relevant information about the intervention and alternative options available
- with adequate knowledge and understanding of the benefits and material risks of the proposed intervention relevant to the older person[1]
Injury
Damage to tissues caused by an agent or circumstance (NSQPCH Standards).[1]
Interoperability
The ability of a system or product to transfer meaning of information within and between systems or products without special effort on the part of the user. (Australian Digital Health Agency)[1]
Last day of life
The hours, days or, occasionally, weeks when a person’s death is imminent. This is sometimes referred to as the period when a person is actively dying. (National Consensus statement, ACSQHC)[1]
Medical practitioner
A person who is registered under the National Law in the medical profession.[2]
Medication management
Practices used to manage the provision of medicines, including:
- How medicines are selected, ordered and supplied
- How older people take medicines or are assisted to take them
- How medicines use is recorded and reviewed
- How medicines are stored and disposed of safely
- How medicines use is supported, monitored and evaluated.
Medication management occurs at both individual and services levels. Medication management has also been described as a cycle, pathway or system, which is complex and involves a number of different health professionals. The older person is the central focus. The system includes manufacturing, compounding, procuring, dispensing, prescribing, storing, administering, supplying and monitoring the effects of medicines. It also includes decision-making, and rules, guidelines, support tools, policies and procedures that are in place to direct the use of medicines.[1]
Medication review
A systematic, comprehensive and collaborative assessment of medicine use and management for an older person. Medication review aims to optimise their medicines and outcomes of therapy by providing a recommendation or making a change. It includes the objective of reaching an agreement with the older person about medicine use in the context of overall treatment, optimising the impact of medicines, minimising the number of medication-related problems and reducing waste.[1]
Multi-Purpose Service Program
Means a specialist aged care program given effect through one or more agreements entered into by the Commonwealth under paragraph 247(1)(a) for the purpose of the delivery of funded aged care services at a place co-located A87with a hospital or other health service as a part of an integrated service arrangement.[3]
Needs, goals and preferences
An older person’s needs, goals and preferences refers to their individual:
- goals of care, including in relation to wellness, independence, reablement and social connections
- needs, including identified care needs including personal care, social engagement, clinical care, food, cultural, religious and spiritual needs
- preferences about the way care is delivered and the things they do and do not like.[1]
Nursing assistant
Means a person: 28 (a) who is not a registered nurse or enrolled nurse; and 29 (b) who works under the direct control and supervision of a 30 registered nurse; and (c) whose work is solely to assist a registered nurse or enrolled
2 nurse in the delivery of nursing.[3]
Ongoing funded aged care service
A funded aged care service delivered by a registered provider to an individual is an ongoing funded aged care service delivered through a service group if:
(a) the individual has an access approval in effect for the classification type ongoing for the service group; and
(b) the provider has given the System Governor a start notification for delivering funded aged care services on that basis to the individual.[3]
Open disclosure
Open discussions with older people, their family, carers and others on issues or incidents that have caused harm or had the potential to cause harm to the older person. It involves an expression of regret and a factual explanation of what happened, the potential consequences and what steps are being taken to manage this and prevent it happening again.[1]
Others involved in the older person’s care
Any individuals or organisations that are involved in delivering care, services or supports to older people. It may involve other aged care providers, health professionals, health services, community organisations, family, carers, etc.[1]
Outcome
The status of an individual, group of people or population that is wholly or partially attributable to an action, agent or circumstance (NSQPCH Standards 2021).[1]
Pain
An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.[1]
Palliative care
Person and family-centred care provided for a person with an active, progressive, advanced disease, who has little or no prospect of cure, who is expected to die, and for whom the primary goal is to optimise the quality of life. Palliative care is care that helps people live their life as fully and as comfortably as possible when living with a life-limiting or terminal illness. Palliative care identifies and treats symptoms which may be physical, emotional, spiritual or social. Palliative care is an approach that improves the quality of life of older people and their carers and families who are facing the problems associated with life-limiting illness, through the prevention and relief of suffering by means of early identification and correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual (National Palliative Care Strategy, 2018)[1]
Person-centred care
An approach to the planning, delivery and evaluation of care that is founded on partnerships between providers and the older person. Person-centred care is respectful of, and responsive to, the preferences, needs and values of the older person. To achieve person-centred care, providers and workers need to:
- work in partnership with older people
- recognise that every person is unique and value the person’s voice, including the knowledge they bring about their care needs
- enable the experiences and expertise of older people to help shape decisions about care at the level of the organisation, service and individual.[1]
Preventative care
Any action taken to keep older people healthy, and prevent or avoid risk of poor health, illness, injury and early death. [1]
Quality care
Care and services that:
- keep older people safe from preventable harm
- are person-centred, provided with kindness and compassion, responding to the holistic needs of the older person and aiming to improve their wellbeing
- are inclusive, culturally safe, trauma aware and healing informed
- are effective, providing the right care to meet the older person’s needs goals and preferences
- are smoothly coordinated when care is provided by the workforce, health professionals and external providers.[1]
Quality of life
An older person’s perception of their position in life taking into consideration their environment and their goals, expectations, standards, and concerns. It includes their emotional, physical, material, and social wellbeing.[1]
Quality and safety culture
A culture of quality and safety that prioritises the safety of older people and the quality of their care and services in all aspects of the decision-making and service delivery. Culture is led from the top. Commitment from leaders and managers is key. Their actions and attitudes influence the perceptions, attitudes and behaviours of the workforce. Other important aspects include:
- shared perceptions of the importance of quality and safety
- constructive communication
- mutual trust
- a workforce that is engaged and always aware that things can go wrong
- acknowledgement at all levels that mistakes occur
- the ability to recognise, respond to, give feedback about, and learn from, complaints and incidents.[1]
Reablement
A process directed by the older person to support restoration of function or adapt to some loss of day-to-day function and regain confidence and capacity for daily activities. It may promote independence, capacity or social and community connections.Reablement focuses on rebuilding or re-establishing the daily living skills and community connections of older people. Reablement is often goal-oriented, aiming to build a person’s skills, strength or function to provide them greater independence, engagement and enable them to undertake activities and reducing reliance on their aged care services. A reabling approach to care and service delivery means that providers actively work with older people to understand the things they like to do, things that may be inhibiting their independence and work with them to identify goals and strategies to help them achieve these goals. Strategies could include learning a new skill, modification to an older person’s home environment or having access to equipment or assistive technology.[1]
Registered Supporters
A registered supporter is someone who helps an older person make and communicate their own decisions about their aged care services.[4]
Restrictive practices
A restrictive practice is any practice or intervention that has the effect of restricting the rights or freedom of movement of an aged care consumer. Under the legislation, there are five types of restrictive practices:
- Chemical restraint
- Environmental restraint
- Mechanical restraint
- Physical restraint
- Seclusion.[1]
Short-term funded aged care service
short-term funded aged care service, a funded aged care service 2 delivered by a registered provider to an individual is a short-term 3 funded aged care service delivered through a service group if: 4 (a) the individual has an access approval in effect for the 5 classification type short-term for the service group; and 6 (b) the provider has given the System Governor a start 7 notification for delivering funded aged care services on that 8 basis to the individual.[3]
Specialist aged care program
Means a program prescribed by the rules under which funded aged care services may be delivered.[3]
Substitute decision-maker
A person appointed or identified by law to make health, medical, residential and other personal (but not financial or legal) decisions on behalf of an older person whose decision-making ability is impaired. A substitute decision-maker may be appointed by the older person, appointed for (on behalf of) the person, or identified as the default decision-maker by legislation, which varies by state and territory (NSQPCH Standards 2021).[1]
Supporter
Means a person registered as a supporter of an individual accessing, or seeking to access, funded aged care services.[3]
Transitions of care
Situations when all or part of an older person’s care is transferred between locations, organisations, providers, or levels of care within the same location, or as the older person’s condition and care needs change (NSQHS Standards, 2nd ed.).[1]
Trauma aware and healing informed care
Trauma aware and healing informed care recognises that a number of older people have experienced trauma in their lives and considers how this may impact them when providing care. Trauma aware and healing informed approaches must be used to restore wellbeing and enable older people to self-manage and control their care decisions.
As part of trauma informed care, providers and workers should:
- understand the effects of trauma on the older person (including through assessment)
- promote safety and trust (create a safe environment, interact in a and respectful way, etc)
- empower older people (by providing transparency, informed consent, collaboration, choice and control)
- build connections, focus on strengths and promote quality of life. [1]
Workforce
People working in an organisation who are responsible for its maintenance or administration, or the care and services, support of, or involvement with, older people. A member of the workforce is anyone the organisation employs, hires, retains or contracts (directly or through an employment or recruitment agency) to provide maintenance or administration, or care and services under the control of the organisation.
It also includes volunteers who provide care and services for the organisation. For clarity, people in an organisation’s workforce include:
- employees and contractors (this includes all staff employed, hired, retained or contracted to provide services under the control of the organisation)
- allied health professionals the organisation contracts
- kitchen, cleaning, laundry, garden and office staff the organisation employs either directly or under contract [1]
