Quality indicators in aged care homes

Pressure injuries are more likely to develop if someone is frail or must stay in bed or a chair. They are also related to changes linked with ageing, such as skin becoming thinner and more fragile.

Other factors that may contribute to the development of pressure injuries include:

• poor nutrition
• reduced mobility
• chronic disease
• incontinence
• the use of restraint.

Thousands of people in Australia are affected by pressure injuries, including older Australians. The risk of getting pressure injuries can be reduced by having effective care strategies in place.

Aged care homes can use the results from the pressure injuries quality indicator to:

• identify and manage risks
• support continuous quality improvement
• improve quality of care.

The best way to prevent pressure injuries is to minimise pressure or friction on skin. An example may be staff helping people who are unable to move on their own to change position regularly. Managing regular pain can also help people stay mobile.

It is important to keep clean, look after the skin, and eat a healthy diet. Plenty of fresh fruit, vegetables, and water can help the skin stay healthy and less likely to become injured.

The person receiving care should have regular check-ups. This can identify if they need help to change positions, or if something else can help like a specialised mattress.

A care plan can be developed if needed. A pressure injury can develop in just a few hours, so regular skin checks by care staff are needed.

Pressure injuries can be hard to heal. Healing can take more time for those who are elderly, frail, do not eat well or move much, and have other health problems. Treating the injury is essential so that it does not get worse.

If the person receiving care gets a pressure injury, they should see a doctor. The aged care home should also make sure care recipients see a wound care nurse, occupational therapist or dietitian if needed.

If you want to know more about the quality of care you or your loved one is receiving, talk to your aged care home.

You might like to ask some of these questions:

• What are you doing to prevent pressure injuries?
• How often are people living in this aged care home assessed for pressure injuries?
• What do you do to treat pressure injuries?
• Are your care staff trained to prevent, recognise and treat pressure injuries?
• What are you doing to improve the prevention and treatment of pressure injuries?
• How do you support physical activity and exercise?

Physical restraints within the QI Program include:

• Mechanical restraints: devices that stop, restrict or reduce a person's movement.
• Physical restraints: physical forces that stop, restrict or reduce a person's movement.
• Environmental restraints: setting restrictions on a person's environment (including items and activities).
• Seclusion: stopping a person from leaving a physical space. This includes solitary confinement.

Physical restraints are often done to influence a person's behaviour. They do not include chemical restraints.

Physical restraints can cause physical and mental harm, even if used as a safety measure. Physical restraint can impact quality of life and lead to:

• cuts and bruising
• pressure injuries
• incontinence
• poor nutrition
• difficulty moving
• falls
• mood swings including anger, withdrawal and aggression
• confusion, anxiety and depression
• loss of trust between older people and their families, and staff
• distress for family members
• serious injury and death.

Aged care homes should regularly review their use of physical restraint. Through this process they may find better ways to support the health, wellbeing and quality of life of people in their care.

Aged care homes can use the results from the physical restraint quality indicator to:

• identify and manage risks
• support continuous quality improvement
• improve quality of care.

Only as a last resort to protect the safety of the person in care. Only use physical restraint if:

• an approved health practitioner with day-to-day knowledge of the person in care thinks that person could harm themselves or others
• alternatives were looked at but did not work
• the least restrictive restraint is used
• informed consent has been given by the person receiving care, or their representative.

This is unless physical restraint is necessary in an emergency.

A restraint-free environment is the recommended standard of care for aged care homes. Some alternatives to physical restraint include:

• reducing the risk of falls and injury by using equipment such as low beds, non-slip mats, and hip protectors
• educating families and staff about dementia and discussing alternative behaviour management strategies
• increasing the safety of the home to allow safe wandering
• exercise and social activities
• taking care of needs such as poor eyesight and mental health, or problems like poor balance or unstable blood pressure.

If you want to know more about the quality of care that you or your loved one is receiving, talk to your aged care home.

You might like to ask these questions:

• What do you do to assess if physical restraint is needed?
• How do you gain consent for the use of restraint?
• How often is the agreed use of a physical restraint reviewed?

If a physical restraint is used:

• Can you explain why physical restraint is needed?
• What alternative ways of managing this issue were considered and tried?
• Has a thorough assessment been completed and recorded?

Unplanned weight loss happens when a person does not eat enough food to meet their daily needs.

There can be complex reasons why not enough food is eaten. It may be the quality of the food, the person may also have difficulty eating.

If the person in care eats a healthy diet, then a specific health condition could be the cause.

Unplanned weight loss is more likely to happen to older people with:

• dementia
• swallowing difficulties
• poor dental health
• chronic disease
• depression
• pain
• the need to take multiple medicines.

Older people are at increased risk of unplanned weight loss and malnutrition. Proper care strategies can reduce the risk of unplanned weight loss.

Aged care homes can use the results from the unplanned weight loss quality indicator to:

• identify and manage risks
• support continuous quality improvement
• improve quality of care.

Aged care homes must monitor the weight of the person in care and address changes as early as possible.

They should consider the quality and taste of food, and any special dietary needs.

It is also important staff receive training to support people with their meals, with taking medication, and with looking after their teeth.

Other areas an aged care home can focus on include:

• encouraging people to eat well by providing tasty, healthy food at the right temperature and serving smaller meals often
• providing a relaxed and sociable dining environment with enough trained staff to help people who need it
• ensuring dental health, swallowing and special dietary needs are addressed by appropriate specialists
• reviewing medicines and medical conditions and considering any possible side effects
• providing choice, discussing food preferences, and developing nutrition care plans together
• getting enough exercise to encourage a healthy appetite
• providing nutritious snacks and finger foods, as well as plenty of water at all hours of the day
• enabling visitors to bring and eat meals at the aged care home.

If the person in care loses weight when they are not expecting to, they should see a doctor. The aged care home should make sure people in their care see a dietitian, dentist or speech pathologist if needed.

If you want to know more about the quality of care that you or your loved one is receiving, talk to your aged care home.

You might like to ask these questions:

• What do you do to make sure people are a healthy weight?
• What meal choices are available?
• How do staff make sure people have enough to eat, and drink enough water?
• Are staff available to help people eat their meals?
• What happens if people experience unplanned weight loss?
• What is the home doing to improve nutrition?

Older Australians are more likely to experience falls, and are more likely to suffer an injury as a result of a fall.

Falls can cause minor and major injury, reduce physical functioning, decrease independence, psychological impacts and occasionally death.

Aged care homes can use the results from the falls quality indicator to:

• identify and manage risks
• support continuous quality improvement
• improve quality of care.

Fall prevention is not always possible. But an awareness of risk factors and some simple steps can reduce the risk of falling and injury.

Aged care homes can focus on three areas to prevent falls:

• assess an individual’s risk of falling by assessing specific risk factors
• put in place prevention or interventions to target the risk factors
• prevent injuries in people who experience falls.

• What processes are in place to assess the risks of falls?
• How are you reducing the risk of falls?
• What are you doing to prevent injuries in those people who fall?
• How do you respond to a fall?

The QI Program describes polypharmacy as the prescription of nine or more medications to a person in care.

Excluded medications are listed in the National Aged Care Mandatory Quality Indicator Program Manual 2.0 Part A (page 31).

Antipsychotics are medications prescribed for the treatment of a diagnosed condition of psychosis.

Psychosis symptoms can include delusions, hallucinations, perceptual disturbances, and severe disruption of ordinary behaviours.

Antipsychotic medication is often prescribed to ease the behavioural and psychological symptoms of dementia.

Polypharmacy is an increasing concern amongst older people.

Polypharmacy monitoring is needed as it can lead to a reduced quality of life. It can lead to side effects, hospitalisation, and impact memory, thinking and decision making.

Inappropriate use of antipsychotics lead to poor health outcomes. It is important to monitor the use of antipsychotics.

Age-related risks can make older people more vulnerable to negative outcomes connected to the use of antipsychotics.

Aged care homes can use the medication management quality indicator results to:

• identify and manage risks
• support continuous quality improvement
• improve quality of care.

• How do you ensure quality use of medications?
• What triggers a medication review?
• How does the service manage the behavioural and psychological symptoms of dementia?
• Who can I speak to if I have concerns about the use of medications at this service?