Aged Care Quality Standards

Standard 1 underscores the importance of valuing diversity where every older person should be treated with dignity and respect, especially in terms of their identity and culture. The Advance Care Planning element in the Clinical Care section of the RAC Toolkit has resources for supporting older people in making their preferences known, communication, decision-making about care, and involving others in their care.

The Assess Palliative Care Needs and Provide Palliative Care elements in the Clinical Care section of the RAC Toolkit has materials on providing care that is culturally safe and offers information on supporting holistic care, including psychosocial and spiritual wellbeing.

Standard 2 focuses on ongoing assessment and planning with older people. It explicitly identifies that this should include advance care and end-of-life care planning if the older person agrees. The Advance Care Planning element of the Clinical Care section of the RAC Toolkit has general information and links to specific states/territories resources for end-of-life planning. There are resources to assist healthcare workers begin the conversation with older persons and their families and carers about how they want to be cared for and what their preferences and values are for their end-of-life care.

The Work Together element of the Clinical Care section of the RAC Toolkit highlights care coordination as essential and inclusive of all health professionals, the older person, and the family and carers regarding care goals. Palliative care case conference information and templates are available to help document the multidisciplinary team meetings.

Standard 3 is concerned with personal and clinical care so that a person’s needs, goals and preferences nearing the end of life are recognised and addressed. This includes older people’s comfort being maximised and their dignity preserved and that the aged care team recognise deterioration and respond in a timely manner. The Recognise End of Life, Respond to Deterioration, Manage Dying and Bereavement elements in the Clinical Care section of the RAC Toolkit provide details to support palliative care and advance care planning.

Standard 4 emphasises the importance of the organisation providing safe and effective services and supports for daily living that optimise the older person’s independence, health, well-being and quality of life. The Assess Palliative Care Needs element of the Clinical Care section of the RAC Toolkit has resources to measure and promote an older person's physical, social and occupational, and psychological, and spiritual well-being.

Standard 5 applies to the physical service environment that the organisation provides for residential aged care, which should be safe, clean, well maintained and comfortable. The Quality Improvement section has materials on policies and procedures to help your organisation build a framework for end-of-life care.

Standard 6 requires an organisation to have a system to support all older people to make a complaint or give feedback. The Getting Started section outlines five actions that will assist your organisation in continuous quality improvement leading to better outcomes.

Standard 7 states that organisations have and use a skilled and qualified workforce, sufficient to deliver and manage safe, respectful, and quality care and services. The Assess Your Knowledge section of the toolkit offers an opportunity for you and your team to evaluate your individual learning and development needs in providing end-of-life care with the ELDAC Personal Learning Assessment (658kb pdf) and Personal Learning Plan (773kb pdf).

Under each element of the ELDAC Care Model in the Clinical Care section of the RAC Toolkit there a list resources to assist your team members in improving their knowledge, skills, and confidence in palliative care and advance care planning.

Standard 8 is about embedding within organisational governance delivery of safe and quality care and services. The Quality Improvement section features two audit tools to support quality improvement in your service, which include the:

• ELDAC Advance Care Planning and Palliative Care Organisational Audit
• ELDAC After Death Audit

Standard 1 underpins how providers and aged care workers are expected to treat older people. It underscores the importance of person-centred care where the older person is treated with dignity and respect, recognising their individuality and diversity, and supporting their independence, choice, and control. Standard 1 is aligned to the Statement of Rights in the Aged Care Act 2024. There are four outcomes each with individual actions. The ELDAC Care Model elements support providers to meet Standard 1. In particular see the Advance Care Planning, Assess Palliative Care Needs and Provide Palliative Care elements in the Clinical Care section of the RAC Toolkit.

Standard 2 sets out the requirements of the governing body to meet the requirements of the Standards and deliver quality funded aged care services. Effective governance systems and a skilled workforce are essential for safe, person-centred care and continuous improvement, empowering aged care workers to perform well. This standard identifies that the governing body is accountable and uses a quality system for continuous improvement, maintains current policies and procedures, and engages with aged care workers. There are ten outcomes each with individual actions. The Quality Improvement section of this toolkit supports the Plan-Do-Act-Check cycle using specifically designed audit tools:

• The ELDAC Advance Care Planning and Palliative Care Organisational Audit
• The ELDAC After Death Audit.

As part of Standard 2 the provider must demonstrate an understanding of workforce needs and plans for the future by monitoring the number and mix of aged care workers required. The provider must ensure sufficient, qualified workers with the skills, qualifications and competencies required to deliver safe, quality care, meeting legislative requirements. The Getting Started section outlines five actions that will assist your organisation to have a coordinated approach to providing palliative care and advance care planning. This includes an action regarding workforce needs.

The Assess Your Knowledge section of the toolkit offers an opportunity for you and your team to evaluate your individual learning and development needs in providing end-of-life care with the ELDAC Personal Learning Assessment (658kb pdf) and to create a Personal Learning Plan (773kb pdf). There are links to education resources to help you and your team improve your knowledge, skills and confidence in palliative care and advance care planning.

Standard 3 describes how providers must deliver services including assessment and planning, communication and a workforce which ensures individualised care. The role of older people's supporters is recognised as crucial in assisting with or providing care. There are four outcomes each with individual actions. Outcome 3.1 is about assessment and planning and Action 3.1.6 specifically identifies that the provider has processes for advance care planning that:

(a) support the individual to discuss future medical treatment and care needs, in line with their needs, goals and preferences, including beliefs, cultural and religious practices and traditions

(b) support the individual to complete and review advance care planning documents, if and when they choose

(c) support the individual to nominate and involve a substitute decision maker for health and care decisions, if and when they choose

(d) ensure that advance care planning documents are stored, managed, used and shared with relevant parties, including at transitions of care.

The Advance Care Planning element of the Clinical Care section of the RAC Toolkit has resources to assist in beginning the conversation with older people about how they want to be cared for and what their preferences are for their end of life including links to specific states/territories resources. There are also resources for families and carers around communication, decision-making about care and involving others in their care.

Standard 3 also focuses on assessment and planning requiring the provider to engage with individuals, their carers, and others involved in their care to develop and review care plans. These plans should outline the older person’s needs, goals, and preferences, including risk management and preventative care strategies, and must be regularly reviewed and used to guide service delivery. The Assess Palliative Care Needs and Provide Palliative Care elements of the Clinical Care section of the RAC Toolkit has materials on providing care that is holistic.

Standard 3 requires the provider to deliver care that meets the needs, goals, and preferences of older individuals, ensuring quality of life, reablement, and function maintenance in a culturally safe manner. This includes implementing evidence-based dementia care, minimising restrictive practices and ensure effective communication and coordination among all parties. The Work Together element of the Clinical Care section of the RAC Toolkit provides information on care coordination including palliative care case conference information and templates to help document the multidisciplinary team meetings.

Other resources to support Standard 3 are available in the Dementia and End of Life Law Toolkits.

Standard 4 applies to the physical service environment which should be safe, clean, well maintained and comfortable. The standard aims to ensure older people receive aged care services in a safe and supportive physical environment that meets their needs including effective infection prevention and control. There are two outcomes with individual actions.

The Getting Started section in this Toolkit has actions to build a framework for delivering end of life care and the Assess Palliative Care Needs and Provide Palliative Care elements of the Clinical Care section of the RAC Toolkit has materials on providing care that is holistic.

Standard 5 is concerned with clinical care so that the older person’s needs, goals and preferences nearing the end of life are recognised and addressed. Operating under a clinical governance framework, aged care workers must deliver quality care to older people including access to various health professionals to optimise their quality of life, reablement, and function maintenance. The standard has seven outcomes with specific actions including one dedicated to palliative and end-of-life care.

Outcome 5.7: Palliative and End-of-Life Care

The Outcome specific to Palliative and end-of-life care states that: The provider must recognise and address the needs, goals and preferences of individuals for palliative care and end-of-life care and must preserve the dignity of individuals in those circumstances. This includes that the pain and symptoms of individuals are actively managed, with access to specialist palliative and end-of-life care when required. It outlines that the provider must ensure that supporters of individuals and other persons supporting individuals are informed and supported, including during the last days of life.

Outcome 5.7 has four Actions:

While all elements of the ELDAC Care Model are relevant to Outcome 5.7. Particular attention for Action 5.7.1 and 5.7.2 should be focused on the Advance Care Planning, Recognise End of Life and Respond to Deterioration elements in the Clinical Care section of the RAC Toolkit. For Action 5.7.3 resources in the Assess Palliative Care Needs, Provide Palliative Care, Work Together and Bereavement elements in the Clinical Care section of the RAC Toolkit are most relevant. For Action 5.7.4 the element on Manage Dying in the Clinical Care section of the RAC Toolkit provides comprehensive resources to respond to the actions.

In addition, the Quality Improvement section features two audit tools to support quality improvement in your service, these are the:

• ELDAC Advance Care Planning and Palliative Care Organisational Audit
• ELDAC After Death Audit.

Other ELDAC Toolkits have resources to support the actions in Outcome 5.7 in particular the End of Life Law Toolkit for legal aspects of care, the Allied Health Toolkit on the role played by allied health practitioners, the Dementia Toolkit has specific resources for people living with dementia and the Managing Risk Toolkit has information on nutrition and hydration, medication management and transfers between settings.

Standard 6 identifies the need for access to nutritionally adequate food as a fundamental human right, significantly impacting an older person's quality of life. Recognising that older people may lose their appetite or face conditions affecting their ability to eat and drink providers need to engage with older people about their food and drink preferences. This might include offering flavourful, appetising, and nutritious choices, including for those with texture-modified diets. Providers should support the older person to eat as much as they want and respect their dignity of risk. Food also plays a vital role in fostering feelings of inclusion and belonging in many cultures. Providers must assess and regularly reassess each individual's nutrition, hydration, and dining needs and preferences, considering specific nutritional requirements, dining needs, food and drink preferences, preferred eating times, and any clinical or physical issues impacting their ability to eat and drink. There are four outcomes with individual actions.

The Assess Palliative Care Needs and Provide Palliative Care elements in the Clinical Care section of the RAC Toolkit have resources on nutrition at the end of life. Further resources are also available in the Managing Risk and Allied Health Toolkits.

Standard 7 recognises that the community is central to the older person’s well-being and the home affords opportunities for meaningful activities and to maintain connections. The provider must also ensure that individuals experience a well-coordinated transition whether planned or unplanned, to or from a provider. There are two outcomes and specific actions. The Advance Care Planning and Respond to Deterioration elements in the Clinical Care section of the RAC Toolkit support transitions in care and the Assess Palliative Care Needs and Provide Palliative Care elements in the Clinical Care section of the RAC Toolkit support the older person’s changing needs, goals and preferences.