This page has information for managers who wish to assess the palliative care currently provided, to identify areas for improvement, or to evaluate changes to service delivery in their facilities. There is information on quality in palliative care in the Nurses section on CareSearch.
When planning changes in your facility, consider how those changes will be evaluated from the start.
The implementation of the Aged Care act 1997 has ensured that all aged care facilities have a continuous improvement program. To achieve accreditation facilities must be able to show compliance against the 44 expected outcomes within the Aged Care Accreditation Standards and that they are actively pursuing continuous improvement across all 4 standards. 
Expected Outcome 2.9, palliative care requires that the comfort and dignity of terminally ill residents is maintained. Many of the expected outcomes in Standard 2 - Health and Personal Care and Standard 3 - Resident Lifestyle, also reflect issues in palliative care provision. Pain management and choice and decision making are two examples.
The National Aged Care Quality Indicator Programme commenced in January 2016. The program assesses aged care facilities on three aspects of care
- Pressure Injuries
- Use of physical restraint
- Unplanned weight loss
Participation in the program is voluntary and results are published on the myaged care website. This program may form part of the aged care facilities continuous improvement program. 
The Australian Aged Care Quality Agency has replaced the Aged Care Standards and accreditation Agency as the body that is responsible for monitoring quality in aged care. The Agency has produced a document Let’s talk about Quality (4.67MB pdf) which discusses current opinion related to quality in aged care.
The South Australian Innovation Hub trial is a federally funded program to improve the quality of aged care by encouraging strong leadership and clinical governance in RAC.
The key documents and resources for quality palliative care in aged care are:
Quality can mean different things to different people which makes it difficult to measure. Assessing quality in palliative care is even more difficult. As quality of care is difficult to measure, quality indicators are often used. These may measure aspects of care given or the experience of care received or the processes in place to ensure quality of care. The Australian Commission on Safety and Quality in Health Care (ACSQHC) looks at national issues around safety and quality in health care and system wide indicators. 
While many Quality Indicators have been developed or are being developed, few have been developed or validated for use in residential aged care. 
A review of assessment scales for measuring palliative care outcomes in residential aged care identified 10 possible tools.  The validity and appropriateness of each is discussed in detail.
Aged care facilities are complex organisations. A systematic review of the relationship between nurse staffing and quality of care in nursing homes was unable to make firm recommendations.  Despite the many papers reviewed the variety of ways quality and staffing were defined and measured, it only gave limited support to the view that total nursing and care staff numbers influence quality of care for residents. The authors also identify that clinical indicators may not reflect the issues that residents would identify as important to the quality of their care.
When assessing quality, be clear about what you are measuring, why it is important and use an appropriate tool.