Indicators of Care

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.

  • Useful Tip

When planning changes in your facility, consider how those changes will be evaluated from the start.

Policy issues

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. [1]

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. [2]

The Aged Care Quality and Safety Commission has replaced the Australian Aged Care Quality Agency as the body that is responsible for monitoring quality in aged care. The Australian Aged Care Quality 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.

Relevant standards

The key documents and resources for quality palliative care in aged care are:

Measuring quality

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. [3]

While many Quality Indicators have been developed or are being developed, few  have been developed or validated for use in residential aged care. [4]

A review of assessment scales for measuring palliative care outcomes in residential aged care identified 10 possible tools. [5] 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. [6] 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.

  • Useful Tip

When assessing quality, be clear about what you are measuring, why it is important and use an appropriate tool.

  1. Australian Aged Care Quality Agency. Accreditation Standards. Parramatta (NSW): Australian Aged Care Quality Agency. Published in the Quality of Care Principles (2014) by the Commonwealth government.
  2. Myagedcare. Quality Indicators in aged care [Internet]. 2016 [updated 2016 Dec 10; cited 2017 Sep 29].
  3. Australian Commission on Safety and Quality in Health Care (ACSQHC). Australian Safety and Quality Framework for Health Care (568kb pdf). Sydney: ACSQHC; 2010 Dec.
  4. Castle NG, Ferguson JC. What Is Nursing Home Quality and How Is It Measured? Gerontologist. 2010 Aug;50(4):426-42. Epub 2010 Jul 14.
  5. Parker D, Hodgkinson B. A comparison of palliative care outcome measures used to assess the quality of palliative care provided in long-term care facilities: a systematic review. Palliat Med. 2011 Jan;25(1):5-20. Epub 2010 Sep 3.
  6. Spilsbury K, Hewitt C, Stirk L, Bowman C. The relationship between nurse staffing and quality of care in nursing homes: A systematic review. Int J Nurs Stud. 2011 Jun;48(6):732-50. Epub 2011 Mar 11.


Clinical Practice

CareSearch Review collection

Last updated 26 March 2019