Put in place strategies for providing quality and safe care and services.

These strategies need to explain how you will deliver care and services plans*. Make sure these strategies describe how care and services will:

• meet the needs, goals, and preferences* of older people (Outcome 1.1)
• be based on contemporary, evidence-based practices* (Outcome 2.3)
• be culturally safe* and appropriate for people with specific needs and diverse backgrounds (Outcome 1.1). For example, if an older person has specific cultural dietary or food preferences, you should document this in their care and services plan*. For residential care home providers, the guidance for Outcomes 6.2 and 6.3 has more information on how you can support older people’s needs and preferences on food, nutrition and the dining experience*. You can also support cultural safety by:
  • providing older people with a culturally safe* and sensitive environment
  • providing opportunities for older people to take part in cultural activities that are meaningful to them, if they wish to do so. This includes supporting them to exercise dignity of risk* (Outcome 1.3). For example, when an Aboriginal and Torres Strait Islander older person wishes to attend cultural activities or ceremonial responsibilities on Country.
• be trauma aware and healing informed* (Outcome 1.1). Make sure you understand and respond to the impacts of trauma and situations that may be triggering of trauma responses. Care and services also need to consider the older person’s psychological needs and past experiences. For example, an older person who has experienced war may be particularly sensitive to loud or unexpected noises. Care leavers may also have difficulty interacting with workers, allied health* and health professionals* based on their past experiences or trauma. Provide older people with a safe and healing environment in line with trauma aware and healing informed care*. For example, make sure the environment or interactions with workers do not resemble an institution.

You can support trauma aware and healing informed care* by:

• providing a safe and supportive environment where older people:
  • feel accepted and valued (Outcomes 1.1 and 1.2). For example, approaching and responding to older people with empathy and positivity.
  • can speak up without reprisal (Outcome 2.6). For example, older people can ask for help which will not lead to criticism. This includes encouraging and providing older people with help to complete surveys and give feedback* and complaints* anonymously if they wish.
• respecting the older person’s autonomy and dignity (Outcomes 1.1 and 1.2). For example, asking for the older person’s permission before attending any care tasks or touching their belongings.
• making sure older people don’t experience discrimination, abuse and neglect when receiving care and services (Outcome 1.2)
• offering older people choices for how you deliver their care and services (Outcome 1.3). This includes recognising the older person’s choice to exercise dignity of risk* and decline tasks they receive care and services.
• working in predictable and transparent ways. You can do this by working in partnership with the older person, their family, carers and others involved in their care and services (Outcome 2.1).
• practising open disclosure* and communicating with older people, their family and carers when things go wrong (Outcome 2.3)
• supporting the older person to select their workers (Outcome 3.2). This can include supporting the older person to choose workers based on their gender and the language they speak (Outcome 1.1). For example, for males from an Aboriginal and Torres Strait Island background, this may include organising a male worker of their choice to attend to personal care or treatment (Outcome 1.2).
• minimising the use of restrictive practices* (Outcome 3.2)
• recognising signs of distress or situations where the older person’s psychological safety* is at risk (Outcome 5.5)
• having strong safety protocols.

Also, make sure these strategies describe how your care and services will:

• optimise older people’s quality of life*, reablement* and help maintain their function. This will support the older person to be as independent as possible. For example, make sure it’s clear how you will:
  • make appropriate and timely* referrals to health professionals* (Outcome 3.4) when you identify risk. This includes professionals from a range of different disciplines. For older people using home care services, this also includes referrals to My Aged Care for them to be reassessed. For example, accessing a physiotherapist in the community for physical reablement after a fall. Use your organisation’s communication system* to manage referrals (Outcome 3.3). This will help you to deliver quality, multidisciplinary care* (Outcome 5.4)
  • support older people to make informed decisions about the care they receive (Outcome 1.3). For example, you can organise a case conference with the older person and the people they want involved in their care with any additional support they need. This can help the older person to feel confident and supported to participate in the discussion.
  • support older people to understand the information you give them. This includes how you give older people access to extra supports to help them to understand the information. This can include advocates, interpreting services to support discussions about care and services and translation of written information into the older person’s preferred language. In addition, this could also include speech pathologists to support communication or using communication aids for those with communication impairment.
  • support older people to exercise dignity of risk* (Outcome 1.3). For example, if an older person has a history of falls* but still wants to go for a daily walk to the shops on their own, you should support them to do this. This includes talking with the older person about the risks and consequences involved. The older person needs to be able to understand how the risks or consequences may affect them. (Outcome 5.5).
  • support older people to take part in activities of daily living*. This includes supporting them to maintain social connections with friends, family and the community (Outcome 1.1). For example, for older people living in a residential care home, provide them opportunities to take part in activities that are meaningful to them. This may include gardening, music and trips in the community (Outcome 7.1). For older people receiving care in the home, provide strategies that support them to take part in social activities with friends, family and the community where possible. This should be informed by each older person’s needs, goals and preferences*.
• maximise worker continuity. For example, having the same care workers regularly* supporting an older person where possible, safe and preferred. This will support the provision of continuity of care (Outcome 3.4).
• provide reasonable opportunities for the older person to choose their workers, where possible. For example, you can support older people to choose workers based on their gender and the language they speak (Outcome 1.1).

Put in place a system* to provide care for people living with dementia*.

Make sure this system* supports safe and quality care* and services for people living with dementia*.

It’s important your system includes processes*:

• to recognise early signs of dementia*. The strategies you use for this should be informed by contemporary, evidence-based practices* (Outcomes 2.3, 5.4 and 5.6)
• for workers to assess the strengths and skills of people living with dementia*. Make sure you encourage older people to use and maintain their strengths and skills (Outcome 1.1). You can collaborate with allied health* and other health professionals* to support older people’s activities of daily living* and quality of life* and to maintain physical, mental and cognitive functions. For example, encourage and provide opportunities for people with dementia that are meaningful and in line with their preferences, such as rinsing their own dishes after a meal. For residential care providers, the guidance for Outcome 7.1 has more information on how you can support older people with activities of daily living*.
• to partner with the older person, their family, carers and health professionals*. You need to involve these people when planning and delivering care and services to the older person (Outcome 2.1).

Put in place processes* to make sure care and services plans* for people living with dementia* meet their individual behaviour support needs (such as mood, memory, thinking and behaviour), as well as their individual needs, goals and preferences*. You need to tailor care and behaviour support strategies to the older person’s individual needs and preferences following best practice behaviour support. This should also be recorded in their behaviour support plan* as part of their care and services plan* (Outcomes 3.1 and 5.6). You need to identify, assess and record any changes in their individual care and behaviour support needs. For example, if a person living with dementia*:

• experiences changed behaviour*. This can include:
  • agitation. For example, when an older person calls out distressed, doesn’t recognise their surroundings and wants to leave.
  • changes in their perception of time.
• Is no longer assessed as needing the use of restrictive practices* as part of their care to manage risks of harm, after they have settled into a new home or environment
• has behaviour support strategies that are no longer effective.

Put in place strategies to minimise the inappropriate use of restrictive practices.

To prevent harm to the older person, or other people, make sure restrictive practices* are:

• only used as a last resort. This means, you need to try tailored and individualised alternative strategies to the extent possible first. Document the use of these strategies in the older person’s behaviour support plan* as part of their care and services plan* (Outcomes 3.1 and 5.6). This includes evaluating the effectiveness of these strategies and considering the likely impact of the use of restrictive practices* on the older person.
• used in the least restrictive form and for the shortest time necessary. This means, there is effective assessment, monitoring and review processes* to make sure the least restrictive option is used.

Also, make sure restrictive practices* are:

• only used if the older person or their restrictive practices* substitute decision-maker* provides informed consent* to the use of the restrictive practice and how it will be used. If the older person lacks the capacity to give their informed consent*, this needs to be obtained from their restrictive practices* substitute decision-maker*. Make sure you document a description of the consultation about the use of the restrictive practice and the giving of valid informed consent*. The guidance material for Outcome 1.3 has more information on informed consent*.
• monitored, reviewed and evaluated regularly* or if there is a change in the older person’s circumstances. Check if there are any appropriate alternative strategies, even if it has been agreed that restrictive practices* can be used. This also includes evaluating the use of these strategies with the aim to reduce and eliminate the need for a restrictive practice.
• documented in the older person’s behaviour support plan* as part of their care and services plan* if used or assessed as necessary. This will guide the safe and appropriate use of restrictive practices*. This includes:
  • any alternative strategies that have been considered and used prior to the use of restrictive practices* (Outcomes 3.1 and 5.6)
  • the documented success and failure of these attempted strategies to inform the older person’s care
  • the changed behaviours* relevant to the need for the use of the restrictive practice
  • how the restrictive practice will be used. This includes its duration, frequency and intended outcome.
  • how the restrictive practice will be monitored and reviewed.

Where restrictive practices* have been assessed as necessary, make sure they are used in line with relevant legislation and the older person’s assessed needs.

Put in place strategies to support workers to deliver quality and safe care and services.

You need to develop these strategies to meet the requirements of your risk management system* (Outcome 2.4).

These strategies need to support workers to:

• recognise risks or concerns about an older person’s health, safety and wellbeing*
• identify deterioration*, changes to an older person’s physical, mental and cognitive functions, or changes in their ability to perform activities of daily living*. This includes changes to an older person’s circumstances, needs, goals and preferences* (Outcome 1.1). For residential care providers, the guidance for Outcome 7.1 has more information on identifying, monitoring and recording older people’s function in relation to activities of daily living*. 
• respond to and escalate risks. Have escalation procedures* to make sure workers know who they can contact if they need support. For example, how to call for assistance and who to escalate concerns to after an older person has a fall*.

Even if you don't deliver clinical care*, you need to be aware of the clinical care* that has been delivered to the older person so you can support workers to identify risks. For example, if an older person has a wound dressing, you, as the provider, will need to understand how you will deliver showering services. This includes how your workers:

• engage with the wound while showering the older person in line with health professional* instructions and advice
• identify signs of wound deterioration* (such as pus) so clinical issues can be appropriately escalated and in a timely* way.

Also, make sure your strategies support workers to:

• make appropriate referrals and confirm these have been made in a timely* manner such as referrals to health professionals*. For example, when workers notice deterioration*, changes to an older person’s physical, mental and cognitive functions, or changes in their ability to perform activities of daily living*.
• make sure older people have access to multidisciplinary care*. This involves input from a variety of health professionals* . Make sure processes are in place to support workers to communicate with each other effectively (Outcome 3.3).
  • for regional and remote providers, limited resourcing may affect timely* access to multidisciplinary care*. These providers should consider strategies to make sure older people are appropriately referred to allied health* and health professionals*.
• maintain and support the older person’s mental health*, cognitive or physical function. Make sure you arrange a medical review if you notice deterioration* in any of these areas (Outcome 5.4).
• share information with older people when they’re delivering care and services based on their language and communication needs and preferences. This can include both verbal and non-verbal communication.
• support older people to use equipment, aids, devices and products safely and effectively. The guidance for Outcomes 4.1a and 4.1b has more information on managing equipment at home and in the service environment.
• involve older people in choosing workers who provide their care.

Make sure your strategies support workers to provide care to people living with dementia*. This includes:

• providing care that is informed by contemporary, evidence-based practices* (Outcome 2.3)
• understanding the way different older people want information to be shared with them. Do this by identifying each older person’s language and communication needs and preferences (Outcome 1.3).
• recognising and responding to changed behaviours* in people living with dementia*. This includes making sure workers have access to behaviour-specific training (Outcome 2.9).

Also, make sure your strategies support workers to minimise the use of restrictive practices*. This includes:

• understanding how to minimise the inappropriate use of restrictive practices*
• clearly and consistently documenting the use of restrictive practices* and how they were monitored
• confirming restrictive practices* were used as a last resort to prevent harm to the older person or other people
• documenting the alternative strategies that have been considered or used prior to the use of restrictive practices*.

Make sure workers who deliver care and services have the time, support, resources and skills to perform their role.

Provide workers with guidance and training on how to deliver quality care and services, relevant to their role (Outcome 2.9). This needs to be in line with:

• the organisation’s policies* and procedures*
• contemporary evidence-based practice*
• workers’ roles and responsibilities*.

Make sure workers understand how to deliver care and services that:

• are culturally safe*, trauma aware and healing informed*
• meet the older person’s needs, goals and preferences*
• optimise the older person’s quality of life*, reablement* and maintenance of function
• recognise and respond to risks, concerns, changes and deterioration* of an older person
• support people living with dementia*. This includes older people experiencing changed behaviours*.
• minimise the use of inappropriate use of restrictive practices*. Where restrictive practices* are assessed as necessary, make sure they are used in line with the older person’s assessed needs.
• include the provision of person-centred behaviour support and best practice alternatives before the consideration or use of a restrictive practice
• enable effective verbal and non-verbal communication with older people. This includes people living with dementia*, or older people who have difficulty communicating and changed communication needs.

The guidance for Outcomes 2.8 and 2.9 has more information on workforce planning and worker training.

Make sure that you deliver care and services safely and meet older people’s needs and preferences.

Regularly* review how you deliver care and services across a sample of older people and workers. You can use information from these reviews to check whether you’re delivering care and services as planned. This can include:

• completing experience surveys with people receiving care
• observing how workers are delivering care
• analysing incident*, feedback* and complaints* information (Outcomes 2.5 and 2.6)
• reviewing clinical and care documents
• talking with older people, their families and carers about the care and services they receive (Outcome 2.1). Ask them if they feel they’re receiving safe and quality care and services that meet their needs, goals and preferences*. These conversations can then inform continuous improvement* actions and planning (Outcome 2.1).

Use this information to find out if:

• workers understand how to:
  • make timely* referrals to health professionals*
  • care for people living with dementia*. This needs to be in line with contemporary, evidence-based practices*.
  • minimise the use of inappropriate restrictive practices*
  • involve older people in selection of workers who provide their care
  • share information with older people when delivering care and services
  • support the older person to use equipment, aids, devices and products safely and effectively.
• the older person’s records are comprehensive and have enough detail to determine what decisions were made, why they were made and who made them. You need to include this information in care and service documents such as progress notes or care and service plans*.
• workers are delivering care in line with the older person’s care and services plan*.

Assess if workers are following your quality system* (Outcome 2.9). You can do this through quality assurance and system* reviews.

If you find any issues or ways you can improve, you need to address them. If things go wrong, you need to:

• practise open disclosure* (Outcome 2.3). This means being open about what has gone wrong. Share what went wrong with older people, their family and carers
• put in place strategies to mitigate the risk of things going wrong again.

The guidance for Outcome 2.3 has more information on monitoring the quality system*.