The Individual | Aged Care Quality and Safety Commission

Intent of Standard 1

Standard 1 underpins the way that providers and aged care workers are expected to treat older people and is relevant to all standards. Standard 1 reflects important concepts about dignity and respect, older person individuality and diversity, independence, choice and control, culturally safe care and dignity of risk. These are all important in fostering a sense of safety, autonomy, inclusion and quality of life for older people.

Older people are valuable members of society, with rich and varied histories, characteristics, identities, interests and life experiences.

Older people can come from a diverse range of backgrounds and groups, including, but not limited to, Aboriginal or Torres Strait Islander persons, people from culturally and linguistically diverse backgrounds, people living in rural or remote areas, people who are financially or socially disadvantaged, people who are veterans, people experiencing homelessness or at risk of becoming homeless, people who are care leavers (i.e. a who spent time in care as a child), parents separated from their children by forced adoption or removal, people who are lesbian, gay, bisexual, transgender or intersex, people of various religions, people experiencing mental health problems and mental illness, people living with cognitive impairment including dementia, people living with disability.

A person’s diversity does not define who they are, but it is critical that providers recognise and embrace each person’s diversity and who they are holistically as a person, and that this drives how providers and aged care workers engage with older people and deliver their funded aged care services.

Governing body

Information for governing bodies*

This guidance should be read in conjunction with Quality Standard 2 which relates directly to the governing body*.

The governing body* plays an important role in aged care and services. They’re responsible for an organisation delivering quality care* and services (Outcomes 2.2 and 2.3).

The governing body* needs to:

supervise provider activities
lead a culture of safety, inclusion and quality
help identify and address issues.

It is important the governing body* puts in place processes* to check the organisation’s strategies for delivering tailored care and services meet each older person’s needs and preferences. This includes monitoring the organisation’s performance, such as by reviewing reports on:

how they’re delivering care and services
how they’re managing complaints*, feedback* and incidents* (Outcomes 2.5 and 2.6)
the quality of care and services workers are delivering. For example, through quality assurance or system reviews (Outcome 2.8).

Make sure the organisation has a culture of safety, inclusion and quality by monitoring and investigating areas you find in the organisation’s reports you can improve. Identify opportunities and make recommendations to your organisation to improve its culture of safety, including quality care*. Provide feedback* and support to the provider*.

You also need to monitor the performance of any subcontracted providers.

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*. This means being open about what has gone wrong. Share this information with older people, their family and carers*
have strategies to reduce the risk of things going wrong again.

The provider* guidance for Outcome 2.3 has more information on open disclosure*.

Standard 2 provides detailed information for governing bodies*.

Key tasks:

Monitor the organisation’s performance in delivering tailored care and services that meet each older person’s needs and preferences.

Evaluate the provider’s* ability to deliver person-centred care* through:

Resident engagement surveys: Regular surveys can capture feedback* from older people about:
- how satisfied they are with their care
- their sense of independence
- whether the care is meeting their preferences.
This feedback helps measure how effective care plans are and identify areas for continuous improvement*.
Consumer advisory body activities: Engaging with a consumer advisory body gives you valuable insights into the experiences and expectations of older people and their families. Regular meetings and discussions help the governing body* and providers* to assess whether care is person-centred* and responds to an older persons’ needs.
Care plan reviews: Regular reviews of care plans in collaboration with the older person, their family, and care staff to make sure the provider is delivering services as planned. It also makes sure you can make any necessary adjustments to meet the person’s changing needs and preferences.
Staff performance evaluations and training: Monitor how staff are performing through evaluations and feedback* and provide ongoing training. This makes sure caregivers are providing high-quality, person-centred and best practice care.
Incident* reporting and follow-up: Analysing incidents* related to care delivery (such as falls or complaints*) helps identify patterns or gaps in care. This helps the organisation to take corrective action and keep improving service quality.

By using a variety of monitoring methods, the governing body* can make sure the organisation is consistently delivering person-centred care* and that any issues are quickly addressed.

Monitor the organisation’s performance to make sure the provider is treating older people with dignity, respect and privacy*.

Monitor the organisation’s performance to check they’re supporting older people to make informed decisions about their care and services.

Monitor the organisation’s performance using systems* for agreements, invoicing and payments.

A provider’s* financial reporting provides transparency that can increase people’s confidence in aged care. The governing body* plays an important role making sure a provider is transparent through oversight and strategic decision-making. By reviewing and using financial reports, the governing body* can meet expectations under Standard 1, particularly Outcome 1.4. This outcome focuses on transparency and managing agreements and resources.

A provider’s* financial reporting includes:

Quarterly financial reports: These reports provide the governing body* with regular updates on the provider's financial health. This helps you to be proactive in your supervision and make informed decisions.
Aged care financial reports including annual prudential compliance statements: These reports make sure providers are complying with financial regulations. They are essential for the governing body* to assess the provider's financial sustainability and risk management.
Annual provider operations report: This report gives the governing body* information on the provider’s overall performance and outcomes. This helps you to make strategic changes and make sure you’re on track with your quality care* and financial goals.

By monitoring financial reporting, the governing body* can strengthen its role in overseeing the provider's financial integrity. This helps make sure that organisations can effectively allocate resources, and that older people receive the care and services they deserve.

You can find more resources about the role of the governing body* and governance* in the Commission Resource Centre.

The Commission developed the Governing for Reform in Aged Care Program to support the key recommendations of the Royal Commission into Aged Care Quality and Safety. The Program supports governing body members, leaders and emerging leaders to strengthen corporate and clinical governance capabilities and enact critical reform.

Workers

What does this Standard mean for workers?

Standard 1 is important for all workers* and is central to your delivery of aged care. This Standard intersects closely with the Statement of Rights and your obligations under the Aged Care Code of Conduct and underpins the way you should treat older people.

Older people tell us that the behaviour of workers* is the most important factor in their aged care experience.

Regardless of your role, you should:

Be respectful and kind to older people. You should treat older people in a way that shows they are valued and supported. Communicate genuinely and honestly to build trust and respect. Listen to the older person and engage with them in a friendly and positive manner.
Build trusting, professional relationships with older people. Build a connection with the older people you deliver care to. Take an interest in who you care for to understand what is important to them and tailor care and services to suit their needs and preferences. This can improve outcomes and satisfaction for both them and you.
Tailor the way you communicate to suit the needs and preferences of the older person. Many older people experience barriers to effective communication, including:
- Hearing or vision loss
- cognitive impairment* or dementia*
- language barriers
- difficulty speaking.
You may need to adapt the way you speak and share information with an older person. This may involve:
- speaking slowly and clearly
- using a translator or interpreting services
- using technology
- using pictures, diagrams or signs
- displaying information in large print or in an accessible format.
You may need to give older people more time and support to understand information and make informed decisions.
- Support older people to feel welcome, included and safe. It can be intimidating for older people to have new people they don’t know deliver their aged care services. This could be welcoming strangers into their own home or entering an unfamiliar residential environment. This is particularly the case for older people who may have experienced trauma or discrimination* in their lives (including Aboriginal and Torres Strait Islander older people, Care Leavers, LGBTIQA+ older people, people from culturally and linguistically diverse backgrounds, and people with cognitive impairment* or dementia*). You should engage with older people in a way that supports them to feel safe, by being respectful and listening to their needs.
- Recognise the autonomy of older people. Older people are free to live the way they choose, make informed choices and exercise dignity of risk*. They have the right to make their own decisions and have the same rights and freedoms as any other member of the community. This includes making decisions about:
  - who they have intimate relationships with
  - their sexual and gender expression
  - what they eat and drink
  - what they do for fun
  - how their privacy is respected.

Even if you disagree with an older person’s lifestyle or choices, it’s not your place to judge or criticise. Where a person has impaired cognitive function or decision-making capacity, use supported decision-making* to help older people make informed decisions and use substitute decision-makers* only after all options to support an older person to make decisions are exhausted.

Tips for workers

Workers* involved in care planning and assessment

You should empower* older people to actively participate in the care planning process*. This is essential to providing individualised care. You can support older people to feel safe to talk about their identity and know that they’re valued, respected and understood.

Workers* delivering care in an older person’s home

Welcoming a stranger into your home can be intimidating for some older people. In this setting, it’s important for you to:

introduce yourself to the older person
explain your role
explain what you will be doing each time you visit their home.

When you visit a person’s home, you are in their private space. Respect their belongings, privacy and relationships.

Key concepts

Person-centred care*

Person-centred care* puts the older person at the centre of their care. It lets an older person’s choices, needs, values and preferences drive the way care is delivered. Person-centred care* is a foundation of safe and quality care*.

The person-centred approach respects each person as an individual. It involves seeking out and understanding what is important to the older person, their family, carers* and loved ones. Person-centred care* is about fostering trust and establishing mutual respect.

Your organisation will have policies* on how to deliver person-centred care*. Some simple ways of showing person-centred care* include:

smiling and introducing yourself
wearing a name tag that people can see and read
explaining your role to the older person
asking the older person how they are feeling today or asking about themselves
treating the older person as an equal partner
listening to the older person and respecting the knowledge they have about their own care and services
listening to their family, carers* and loved ones
making sure the older person has all the information in a way they can understand and has the time they need to make informed choices.

Trauma aware and healing informed care*

Trauma aware and healing informed care* recognises that older people may have experienced trauma and that this can affect the way they behave. Trauma can include:

the loss of a loved one
abuse
assault
serious accidents
war
natural disasters
other impactful experiences, such as institutionalisation.

Trauma can remove a person’s sense of safety or control. Trauma aware and healing informed* care supports older people to feel safe and gives them a choice in the way care is provided. This concept includes:

asking permission
describing what you’re going to do
receiving permission
following through in a way that is predictable and reliable.

Like person-centred care*, this concept involves understanding and respecting a person’s choices, preferences and life experiences.

Trauma-aware care is particularly important when caring for older Aboriginal and Torres Strait Islander people. Aboriginal and Torres Strait Islander people may have experienced intergenerational trauma or specific impacts related to colonisation, dispossession or systemic discrimination*. Workers* should be mindful of these unique experiences and use trauma aware and healing informed care* in culturally safe* and sensitive ways.

Culturally safe care*

All older people have the right to culturally safe care*. Culturally safe care* recognises, respects and supports the unique cultural identities of older people. It meets their needs and expectations and upholds their rights. Culturally safe care* is accessible and responds to different people’s needs. This is care that is free from judgement, discrimination* and racism.

Culturally safe care* is particularly important when caring for older Aboriginal and Torres Strait Islander people, who may have unique cultural identities, histories and needs. It’s also important when caring for older people from culturally and linguistically diverse (CALD) backgrounds. Older people with CALD backgrounds may face language barriers or cultural differences and may have experienced discrimination*.

To practise cultural safety, you need to listen and learn from the older people you provide care to and develop a shared respect, meaning and knowledge.

Practising cultural safety is an ongoing commitment. You need to be aware of your own culture, values and attitudes and how it may influence you. Only the person receiving care can determine whether it’s culturally safe* – this means you have to engage with them, listen to them and provide care in a way that they have agreed to, with their permission.

Your organisation must provide you with ongoing training and support on cultural safety and how it should be applied in your role.

Supported decision making

Every older person has the right to make decisions about their life, the care and services they receive, and the risks they are willing to take. This includes people living with dementia* or other forms of cognitive impairment*.

There may be times where an older person wants or needs support to make a decision. A person’s decision-making capacity may change over time, as will the support they need to make different types of decisions. Strategies for supporting decision making include:

clearly explaining an older person's options (and what it means in practice for them) in a way they can understand
building the older person’s skills and knowledge to make decisions
working with the older person’s carers*, families and loved ones to build their capacity to support the older person to make decisions.
complying with any supported decision-making* plans or agreements an older person has in place.

Supported decision-making* requirements vary between jurisdictions. Your organisation will have policies* to support this key concept. It’s important you understand your organisation’s policies* and your role in supporting older people to make decisions.

Dignity of risk*

Dignity of risk* supports an older person’s independence and right to make their own choices, even if those choices involve some risk. If an older person’s choices are possibly harmful to them, you are expected to help them understand the risk and how it could be managed to help them live the way they choose.

Dignity of risk* applies to many aspects of an older person’s life including, but not limited to, food and drink choices. Other examples include an older person:

wanting to take part in physical activities
continuing to live in a less-supported environment
taking part in hobbies or relationships that involve some degree of risk.

It’s important to support these choices, while balancing safety considerations.

Some older people may choose to consume food and drink that have been identified as a risk to them. Those risks could be caused by:

certain ingredients (such as sugar, salt or fat)
the meal’s serving size
fast food
food cooked by the family
food that could be difficult to swallow or lead to choking*.

Older people can choose to accept these risks so they can enjoy their meal. You must respect their decision. Where an older person lacks capacity to make an informed decision, you will need to work with their substitute decision maker* to find a solution that best supports the older person’s wellbeing* and independence.

Supporting older people to make informed choices about all aspects of their food, drink and the dining experience* is a key part of maintaining their quality of life*.

Risk management, as outlined in Standard 2, is essential to applying dignity of risk* in practice. It involves identifying potential risks, discussing them openly with the older person or their substitute decision-maker*, and using strategies to manage those risks while respecting their choices.