Quality of care and support for older persons

The services specified in this document are health and social care services for older persons provided by healthcare and social care personnel. This document
-   specifies requirements and recommendations for services provided to the older person at home and in care homes, based on the older person's individual needs and preferences to assist self-determination, participation, and a safe and secure old age.
-   specifies requirements and recommendations for systematic approaches regarding the service provider’s ability to produce a good quality of care and support for the older person.
-   covers services irrespective of the legal form of ownership and whether the service is publicly or privately funded.
-   is applicable to care providers, regardless of structure, organization, ownership, size or type of the care services provided.
-   can be used by the service provider at all management levels in the organization to plan, lead, implement, maintain, evaluate and improve the quality of the service.
-   can be used by the provider for internal audits or self-assessment and/or external parties for certification/accreditation to assess the provider’s ability to meet the older person´s needs and expectations.
-   can be used to provide basic information for procurement and education.
-   does not cover standardization of medical devices and clinical guidelines.

Qualität der Pflege älterer Menschen - Dienstleistungen, die in der eigenen Wohnung erbracht werden, einschließlich betreutem Wohnen

Bei den in diesem Dokument aufgeführten Dienstleistungen handelt es sich um Gesundheits- und Sozialfürsorgedienste für ältere Menschen, die von Gesundheits- und Sozialfürsorgepersonal erbracht werden.
Dieses Dokument:
-   beschreibt Anforderungen und Empfehlungen für Pflegeleistungen, die den älteren Personen zu Hause und in Pflegeheimen geboten werden, basierend auf den individuellen Bedürfnissen und Wünschen der älteren Person, um die Selbstbestimmung, die Mitbestimmung und ein sicheres Älterwerden zu unterstützen.
-   beschreibt Anforderungen und Empfehlungen für systematische Ansätze hinsichtlich der Fähigkeit des Anbieters, eine gute Qualität der Pflegeleistung und Betreuung für die ältere Person zu gewährleisten.
-   behandelt Dienstleistungen unabhängig von der Rechtsform und unabhängig davon, ob die Dienstleistung öffentlich oder privat finanziert wird.
-   ist auf Anbieter anwendbar, unabhängig von Struktur, Organisation, Trägerschaft, Größe oder Art der angebotenen Pflegedienste.
-   kann vom Anbieter der Pflegeleistung auf allen Management-Ebenen in der Organisation zur Planung, Leitung, Implementierung, Aufrechterhaltung, Beurteilung und Verbesserung der Leistungsqualität verwendet werden.
-   verlangt vom Anbieter, den Leistungsinhalt der Organisation in einer Dienstbeschreibung zu erläutern, die z. B. eine Erklärung über Zweck und Art des Pflegedienstes, Maßnahmen zur Gewährleistung des Wohlbefindens und der Sicherheit der älteren Menschen, die ethischen Grundsätze, die angebotenen Dienste und Einrichtungen, das Management und das Personal in Bezug auf Fähigkeiten und Anzahl, Methoden zur Qualitätskontrolle und Beurteilung des Dienstes enthält.
-   fordert den Anbieter auf, die Dienstleistungsbeschreibung mit dem Inhalt dieses Dokuments zu vergleichen und bietet bei Bedarf eine Erklärung, in der beschrieben wird, welche Abschnitte, Anforderungen und Empfehlungen, die nicht in der Dienstleistungsbeschreibung enthalten und daher nicht auf die Dienstleistungen des Anbieters anwendbar sind.
-   kann vom Anbieter für interne Audits oder Selbstbeurteilung und/oder von externen Parteien für die Zertifizierung/Akkreditierung verwendet werden, um die Fähigkeit des Anbieters zu beurteilen, die Bedürfnisse und Erwartungen der älteren Person zu erfüllen.
-   kann verwendet werden, um grundlegende Informationen für Beschaffung und Ausbildung zu geben.
-   umfasst nicht die Normung von Medizinprodukten und klinischen Richtlinien.

Qualité des soins et de l'accompagnement des personnes âgées

Les services spécifiés dans le présent document sont des services de soin et des services d'aide sociale pour les personnes âgées, dispensés par un personnel de soins de santé et d'aide sociale.
Le présent document :
-   spécifie les exigences et recommandations applicables aux services dispensés à la personne âgée à domicile et dans des maisons de santé, compte tenu des besoins et préférences personnels de la personne âgée, afin de favoriser l'autodétermination, la participation et la vieillesse dans des conditions sûres et sécuritaires ;
-   spécifie les exigences et recommandations applicables aux approches systématiques concernant la capacité du prestataire de services à produire une bonne qualité de soins et d'accompagnement pour les personnes âgées ;
-   couvre les services quelle qu'en soit la forme de propriété juridique, et qu'ils soient financés par des fonds publics ou privés ;
-   est applicable aux prestataires de soins, quels que soient leur structure, leur organisation, leur propriétaire, leur taille ou les types de prestations de soins qu'ils proposent ;
-   peuvent être utilisés par le prestataire de services à tous les niveaux de direction de l'organisme pour planifier, conduire, mettre en œuvre, maintenir, évaluer et améliorer la qualité du service ;
-   exige de la part du prestataire de décrire le contenu des services de son organisme dans une description des services, qui comprend, par exemple, une déclaration de l'intention et de la nature des services de soins, des mesures pour garantir le bien-être et la sécurité des personnes âgées, les principes éthiques, les services et les installations fournis, les aptitudes de la direction et du personnel ainsi que leur effectif, les méthodes de contrôle de la qualité et d'évaluation du service ;
-   exige de la part du prestataire de comparer la description des services au contenu du présent document et, si nécessaire, de fournir une déclaration qui décrit les articles/paragraphes, les exigences et les recommandations qui ne sont pas inclus dans la description des services et qui donc ne s'appliquent pas aux services du prestataire ;
-   peut être utilisé par le prestataire dans le cadre d'audits internes ou d'une auto-appréciation et/ou par des parties externes à des fins de certification/d'accréditation pour évaluer l'aptitude du prestataire à satisfaire aux besoins et attentes de la personne âgée ;
-   peut être utilisé pour fournir des informations de base pour l'approvisionnement et l'enseignement ;
-   ne couvre pas la normalisation des dispositifs médicaux et des recommandations de bonnes pratiques.

Kakovost oskrbe in pomoči za starejše

General Information

Status
Published
Public Enquiry End Date
31-Jul-2020
Publication Date
12-Dec-2021
Technical Committee
Current Stage
6060 - National Implementation/Publication (Adopted Project)
Start Date
08-Dec-2021
Due Date
12-Feb-2022
Completion Date
13-Dec-2021

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SLOVENSKI STANDARD
SIST-TS CEN/TS 17500:2022
01-februar-2022
Kakovost oskrbe in pomoči za starejše
Quality of care and support for older persons

Qualität der Pflege älterer Menschen - Dienstleistungen, die in der eigenen Wohnung

erbracht werden, einschließlich betreutem Wohnen
Qualité des soins et de l'accompagnement des personnes âgées
Ta slovenski standard je istoveten z: CEN/TS 17500:2021
ICS:
03.120.99 Drugi standardi v zvezi s Other standards related to
kakovostjo quality
11.020.10 Zdravstvene storitve na Health care services in
splošno general
SIST-TS CEN/TS 17500:2022 en,fr,de

2003-01.Slovenski inštitut za standardizacijo. Razmnoževanje celote ali delov tega standarda ni dovoljeno.

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SIST-TS CEN/TS 17500:2022
CEN/TS 17500
TECHNICAL SPECIFICATION
SPÉCIFICATION TECHNIQUE
November 2021
TECHNISCHE SPEZIFIKATION
ICS 11.020.10
English Version
Quality of care and support for older persons

Qualité des soins et de l'accompagnement des Qualität der Pflege älterer Menschen -

personnes âgées Dienstleistungen, die in der eigenen Wohnung erbracht
werden, einschließlich betreutem Wohnen

This Technical Specification (CEN/TS) was approved by CEN on 17 October 2021 for provisional application.

The period of validity of this CEN/TS is limited initially to three years. After two years the members of CEN will be requested to

submit their comments, particularly on the question whether the CEN/TS can be converted into a European Standard.

CEN members are required to announce the existence of this CEN/TS in the same way as for an EN and to make the CEN/TS

available promptly at national level in an appropriate form. It is permissible to keep conflicting national standards in force (in

parallel to the CEN/TS) until the final decision about the possible conversion of the CEN/TS into an EN is reached.

CEN members are the national standards bodies of Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia,

Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway,

Poland, Portugal, Republic of North Macedonia, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and

United Kingdom.
EUROPEAN COMMITTEE FOR STANDARDIZATION
COMITÉ EUROPÉEN DE NORMALISATION
EUROPÄISCHES KOMITEE FÜR NORMUNG
CEN-CENELEC Management Centre: Rue de la Science 23, B-1040 Brussels

© 2021 CEN All rights of exploitation in any form and by any means reserved Ref. No. CEN/TS 17500:2021 E

worldwide for CEN national Members.
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Contents Page

European foreword ...................................................................................................................................................... 4

Introduction .................................................................................................................................................................... 5

1 Scope .................................................................................................................................................................... 8

2 Normative references .................................................................................................................................... 8

3 Terms and definitions ................................................................................................................................... 8

4 Organizational and technical processes ............................................................................................... 14

4.1 Organization, management, and resources ......................................................................................... 14

4.2 Personnel — knowledge, skills, and numbers ................................................................................... 16

4.3 Ethical principles .......................................................................................................................................... 19

4.4 Health promotion and wellbeing ............................................................................................................ 20

4.5 Assistive devices – systems, technology, and related services ..................................................... 21

4.6 Accessibility and the built environment .............................................................................................. 22

4.7 Cleaning, hygiene and infections ............................................................................................................. 24

5 Initial processes, assessment, agreement and documentation .................................................... 26

5.1 Initial assessment of needs ....................................................................................................................... 26

5.2 Agreements and contracts related to the older person .................................................................. 27

5.3 Documentation – plans, agreements, initiatives and results ........................................................ 28

6 Main processes – Social and community life ....................................................................................... 29

6.1 Rights, diversity, integrity and participation ..................................................................................... 29

6.2 Security and safety ....................................................................................................................................... 31

6.3 Communication and information ............................................................................................................ 32

6.4 Activities .......................................................................................................................................................... 33

6.5 Informal caregivers – people close to the older person and volunteers .................................. 35

7 Main processes – Health and wellbeing ................................................................................................ 35

7.1 Health literacy ................................................................................................................................................ 35

7.2 Assessment of care and support during ongoing care .................................................................... 36

7.3 Cognitive function and mental health ................................................................................................... 37

7.4 Food, drink, meals and nutrition ............................................................................................................ 38

7.5 Oral and dental health................................................................................................................................. 40

7.6 Bladder and bowel function ...................................................................................................................... 40

7.7 Personal care, skin and wounds .............................................................................................................. 41

7.8 Pain .................................................................................................................................................................... 42

7.9 Medications ..................................................................................................................................................... 42

7.10 End of life and palliative care ................................................................................................................... 44

8 Quality assurance ......................................................................................................................................... 46

8.1 Systematic quality work ............................................................................................................................. 46

8.2 Quality statement ......................................................................................................................................... 47

8.3 Quality management systems .................................................................................................................. 47

8.4 Suggestions and complaints ...................................................................................................................... 48

8.5 Prevention and management of risks ................................................................................................... 49

8.6 Non-conformities and adverse events ................................................................................................... 50

8.7 Evaluation of processes, activities and outcomes ............................................................................. 51

8.8 User feedback ................................................................................................................................................. 51

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8.9 Internal audits ............................................................................................................................................... 52

8.10 Self-assessment ............................................................................................................................................. 53

Annex A (informative) The integrated care concept, healthcare and social care .............................. 54

Annex B (informative) Needs, wishes, assessment and assessment tools ............................................ 56

Annex C (informative) Compliance with requirements and recommendations ................................. 60

Bibliography ................................................................................................................................................................. 62

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European foreword

This document (CEN/TS 17500:2021) has been prepared by Technical Committee CEN/TC 449 “Quality

of care for older people”, the secretariat of which is held by SIS.

Attention is drawn to the possibility that some of the elements of this document may be the subject of

patent rights. CEN shall not be held responsible for identifying any or all such patent rights.

Any feedback and questions on this document should be directed to the users’ national standards body.

A complete listing of these bodies can be found on the CEN website.

According to the CEN/CENELEC Internal Regulations, the national standards organisations of the

following countries are bound to announce this Technical Specification: Austria, Belgium, Bulgaria,

Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland,

Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Republic of

North Macedonia, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and the

United Kingdom.
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Introduction
Development of care and support

In Europe, the population of older persons requiring care and support services is increasing. Older

persons are generally defined according to a range of characteristics including chronological age,

change in social role and changes in functional abilities. In high-resourced countries older age is

generally defined in relation to retirement from paid employment and receipt of a pension.

There is a need for a shift in the way societies are organized and a change in the way older persons and

ageing in general are perceived. Building on the concepts of active ageing and age-friendly

environments, this document, Quality of care and support for older persons, stresses the importance of

enabling the older person in need of care and support to be involved and empowered to decide how

their needs, expectations and preferences can be met to live as autonomously as possible.

This document promotes the idea that the older person has the right to age with dignity, to be respected

and to be included as a full member of society. Promoting a rights-based approach means, for example,

fighting age discrimination, protecting service users’ rights, ensuring access to reliable and

comprehensive information, promoting a more accessible environment, and support for mobility,

communication, consultation, and participation.

Accessibility and availability of care and support services also play a critical role in ensuring the

inclusion of the older person. This means that the older person can use a service regardless of age,

geographical location, illness, disability, or functional limitation.

Important factors in quality development are that the older person maintains control over their own life

and that their needs and preferences are considered in the planning and provision of the care and

support. It should be a priority to develop a person-centred approach in all services, to maintain the

dignity, participation, and empowerment of the older person in need of care and support.

Provision of care and support needs to evolve

In general care and support of the older person services are of a good standard Despite this, threats to

the quality of care and support sometimes can come from outdated ideas and ways of working, which

often focus on keeping the older person alive rather than on supporting dignified living and maintaining

their intrinsic capacity. In this case, the older person may be regarded as a passive recipient of care and

support, and services may be organized around the service provider rather than the needs and

preferences of the older person. Care and support may focus on meeting the older person’s basic needs,

such as eating, showering or dressing, at the expense of the broader objectives of ensuring wellbeing,

that life has meaning, and that the older person feels respected.

With these aspects in mind, care and support ought to evolve in radical ways if the growing needs of

older persons are to be sustainably met. The transformation will require a coordinated and

multisectoral response that involves a wide range of stakeholders, both within and outside

governments. The most important participant being the provider, in the sense that it is the provider

who can ensure that the autonomy and will of the older persons are respected. More fundamentally,

mindsets about what care and support might comprise should be reset. New ways of thinking about

integrated care and support, and the systems for providing it, need to be developed. All relevant

stakeholders need to be responsive, empathetic, proactive, and innovative.

Changes need to encompass two broad areas. Firstly care and support of the older person needs to be a

priority agenda issue both societally and politically Second, care and support needs to be redefined.

Instead of thinking about care and support as a minimum and basic safety net that provides

rudimentary support to older persons who can no longer look after themselves, perceptions need to

shift towards a more positive and proactive agenda. Within this new framework, care and support

ought to be oriented towards both optimizing intrinsic capacity and compensating for a lack of capacity

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to maintain the older person's integrity and functional ability and ensuring dignity and wellbeing and

the opportunity for activity and participation in society.

An integrated response ensures that the provision of care and support is optimized

In several European countries, the competencies for health services and social services are separated

from each other in two different service systems for older persons and is not considered as a specific or

separate sector of the social security system, and health and social services are not regulated by a single

legal scheme and administered by one single national and/or regional body. Thus, the healthcare and

the social care components of care are provided by different actors, which are registered, evaluated,

and operated according to different roles and organizational structures for healthcare and for social

care services. Depending on the degree of integration between healthcare and social care systems, the

care provided to the older person can be managed by one or several providers.

The integration between social care and health care, both administratively and at the points of use, is a

crucial factor in care quality. The separation of social care and health care services can result in

fragmented coverage, gaps in the provision of care and inappropriate use of acute services. More and

better coordination is needed at a systems level. See also Annex A (informative).

An integrated response to care and support covers very different types of care: health care, social care,

care for cognitive diseases, palliative and end-of-life care, services provided at home, in day care

centres, in day hospitals or in care homes, public or private-funded, informal care or care by volunteers.

Informal caregivers provide a high amount of care and support, for their beloved relative. The quality of

life of the informal caregiver is close linked to the quality of life of the older person in need of care and

support. Moreover, the provider can facilitate the building of networks with the aim of care providing

personnel giving support to the informal caregivers.

Health promotion and preventive approaches improve the quality of life of older persons

Health promotion and risk prevention offer the potential for improving the quality of life for the

growing population of older persons, while reducing the economic burden on the health system.

The World Health Organization describes health promotion as: ‘The process of enabling people to

increase control over, and to improve, their health.” It moves beyond a focus on individual behaviour

towards a wide range of social and environmental interventions.

A health promotion and prevention approach to care and support can provide the older person with the

knowledge and skills to remain independent and well for a longer period and to reduce the impact of

frailty syndromes e.g. falls, polypharmacy etc on their health and wellbeing Health promotion and

preventive approaches benefit not only the older person, but also the organizer and producer of care

and support services by reducing and postponing the need for heavy care and support services and thus

being cost-effective. Good and nutritious food, physical activity and strong social networks can help to

prevent illnesses and chronic diseases. Health consultation, counselling and safer treatment with

medication are other ways to prevent health risks among older persons.
How to read and apply this document

This document is intended to be useful to all types and sizes of providers in the private, public, and non-

profit sectors. While not all parts of this document will be of equal use to all types of providers, the

principles are relevant to every provider.

Provision of care and support consists of processes embedded in complex systems that are inevitably

linked to or require the incorporation of other existing and future standards outside of this document

and related to fields, such as accessibility (of processes, products, and services), ergonomics, social

responsibility, human resource management, assistive devices and products, sustainable development

in communities, smart homes, cognitive accessibility user interfaces, privacy and data management.

This document is an example of an interdisciplinary approach that has special focus on care and

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support, and it is important that the provider identifies and incorporates the use of other

complementary standards.

This document uses the term ‘care and support’ for the combination of healthcare services and social

care services. The document aims to facilitate the development of care and support services by

establishing common denominators that are agreed on as fundamentals of care and support.

This document can be used by the service provider at all management levels in the organization to plan,

lead, implement, maintain, evaluate, and improve the quality of the service.
When starting to use this document, each service provider

— describes the organizations service content in a service description, which includes for example a

statement of purpose and character of the care and support service, measures for ensuring the

older persons’ wellbeing and security, the ethical principles, the services and facilities provided,

management and personnel in terms of skills and numbers, methods for quality control and

evaluation of the service.

— compares the service description with the content of this document and, when needed, gives a

statement that lists what clauses, requirements and recommendations that are not in the service

description and therefore not applicable to the provider’s services.

The document can be used by the provider for internal audits or self-assessment and/or external

parties for certification/accreditation to assess the provider’s ability to meet the older person’s needs

and expectations.

The document can be used to provide basic information for procurement and education of the

personnel.

Establishing quality of care and support for older persons requires knowledge of the ageing process, a

gerontological skill set and a positive attitude to ageing. . Involvement and engagement of all

management chain is crucial when implementing quality of care and support for older persons. When

the management is committed to quality requirements and recommendations, they pass down

knowledge to their personnel and motivate them to be involved. Good communication helps to create a

committed and supportive atmosphere, and thus has a positive influence on the implementation of this

document and continuous improvement of quality.

The requirements and recommendations given in this document are actions to be taken by the provider.

Requirements and recommendations are listed in Clauses 4 to 8 after the introduction and explanation

of the terminology used. These sections start with short general introductions which provide a brief

background to the following requirements and recommendations.

This document uses the words ‘general’ and ‘specific’ in relation to requirements and recommendations

in the following way:

• General requirements and general recommendations apply to all care and support services

regardless of whether they are provided at home or at a care home.

• Specific requirements and specific recommendations apply mainly to care and support services

provided in a care home but shall/should also be applied to care and support services given at

home when such services are in the service description of the provider.
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1 Scope

This document specifies requirements and recommendations for the provision of health and social care

services for older persons provided by healthcare and social care personnel, irrespective of whether the

service is provided in the persons own home or in a care home.

Service provision is based on the individual needs and preferences of the older person to assist self-

determination, participation and a safe and secure old age.

This document applies to all providers of care and support to older persons irrespective of size,

structure, legal set up, or funding model (i.e. public or private).

This document does not cover standardization of clinical guidelines and/or medical devices.

2 Normative references
There are no normative references in this document.
3 Terms and definitions
For the purposes of this document, the following terms and definitions apply.

ISO and IEC maintain terminological databases for use in standardization at the following addresses:

— IEC Electropedia: available at https://www.electropedia.org/
— ISO Online browsing platform: available at https://www.iso.org/obp
3.1
care and support

activities within health care services, social care services or an integration of both, including care

provided by informal carers

Note 1 to entry: An informal carer includes any person such as a family member, friend, or a neighbour, who

provides regular ongoing assistance to another person.

Note 2 to entry: Support is mixture of practical, financial, social, and emotional activities for persons who need

extra help to manage their lives and to be independent.
[SOURCE: EN 17398:2020 modified. Support introduced in title and Note 2 added]
3.2
service

output of a provider with at least one activity necessarily performed between the provider and the

customer
Note 1 to entry: The dominant elements of a service are generally intangible.

Note 2 to entry: Service often involves activities at the interface with the customer to establish customer

requirements as well as upon delivery of the service and can involve a continuing relationship such as banks,

accountancies, or public organizations, e.g. schools or hospitals.
Note 3 to entry: A service is generally experienced by the customer.

[SOURCE: ISO 9000:2015, 3.7.7 modified — definition has been abbreviated and aligned with 3.24]

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3.3
healthcare services

services covering the whole spectrum of care, from promotion and prevention to diagnostic,

rehabilitation and palliative care, as well as all levels of care including self-care, home care, community

care, primary care, long-term care and hospital care for the purpose of providing integrated health

services throughout life
[SOURCE: EN 17398:2020]
3.4
social care services

activities undertaken by social care personnel that focus on help and support in coping with activities of

everyday life

Note 1 to entry: The content of the social care varies between the European countries and in some countries,

health and social care are integrated and the tasks carried out in the elderly care can thus not be divided into

healthcare or social care.
Note 2 to entry: Social care also aims to prevent abuse and neglect.
3.5
integrated care

coordinated provision of care and support (public, private, personal/family/informal) provided to

ensure practicable autonomy and independence of the older person
3.6
care provider

organization or care professional providing care and support services to older persons in need of care

and support

Note 1 to entry: Depending on the needs of the older person the care and support can be provided at the persons

own home, day care centres or care homes.

Note 2 to entry: The service can be provided by public, private or non-profit organizations.

Note 3 to entry: The service can consist of healthcare, social care, or a combination of both.

3.7
care home

place of residence for persons with physical and/or mental disabilities, who may require nursing care

to perform daily living activities

Note 1 to entry: The facility provides 24-h supervision, nursing care, rehabilitation programmes and social

activities as well as assisting contact with the social environment, including assistance with asserting rights,

justified interests, and handling personal matters.
Note 2 to entry: care homes are often referred to as nursing homes.

Note 3 to entry: A care home might specialize in certain types of disability or conditions such as dementia.

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3.8
home

habitual residence, such as an apartment or house, of the older person and their family

Note 1 to entry: The older person’s home can be located in an accommodation specifically designed for older

persons
3.9
home care

healthcare and social care given at the person's home aimed at preserving and increasing functional

ability and enable the older person to remain at home

Note 1 to entry: The care and support is provided to older persons in their own homes with a view to not only

contributing to their life quality and functional health status, but also to replace hospital care with care in the

home for societal reasons. Home care can cover a wide range of activities, from preventive visits to end-of-life

care.
3.10
individual care plan

plan developed on the basis of initial and continuous assessment of needs, expectations, objectives and

individual resources developed by the care team (including plans developed by professionals, see 3.22)

of the provider or by the commissioner of the care in cooperation and agreement with the older person

Note 1 to entry: The older person’s individual care plan covers all aspects of health and social care and describes

how these will be met in terms of daily living and longer-term outcomes. The plan also includes plans for how and

when evaluations and reassessments are carried out.

Note 2 to entry: In many European countries, plans and records concerning healthcare and social care are kept as

separate entities and governed by different laws. Wh
...

SLOVENSKI STANDARD
oSIST prEN 17500:2020
01-julij-2020
Kakovost oskrbe in pomoči za starejše
Quality of care and support for older persons

Qualität der Pflege älterer Menschen - Dienstleistungen, die in der eigenen Wohnung

erbracht werden, einschließlich betreutem Wohnen
Qualité des soins et de l'accompagnement des personnes âgées
Ta slovenski standard je istoveten z: prEN 17500
ICS:
03.120.99 Drugi standardi v zvezi s Other standards related to
kakovostjo quality
11.020.10 Zdravstvene storitve na Health care services in
splošno general
oSIST prEN 17500:2020 en,fr,de

2003-01.Slovenski inštitut za standardizacijo. Razmnoževanje celote ali delov tega standarda ni dovoljeno.

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oSIST prEN 17500:2020
DRAFT
EUROPEAN STANDARD
prEN 17500
NORME EUROPÉENNE
EUROPÄISCHE NORM
April 2020
ICS 11.020.10
English Version
Quality of care and support for older persons

Qualité des soins et de l'accompagnement des Qualität der Pflege älterer Menschen -

personnes âgées Dienstleistungen, die in der eigenen Wohnung erbracht
werden, einschließlich betreutem Wohnen

This draft European Standard is submitted to CEN members for enquiry. It has been drawn up by the Technical Committee

CEN/TC 449.

If this draft becomes a European Standard, CEN members are bound to comply with the CEN/CENELEC Internal Regulations

which stipulate the conditions for giving this European Standard the status of a national standard without any alteration.

This draft European Standard was established by CEN in three official versions (English, French, German). A version in any other

language made by translation under the responsibility of a CEN member into its own language and notified to the CEN-CENELEC

Management Centre has the same status as the official versions.

CEN members are the national standards bodies of Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia,

Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway,

Poland, Portugal, Republic of North Macedonia, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and

United Kingdom.

Recipients of this draft are invited to submit, with their comments, notification of any relevant patent rights of which they are

aware and to provide supporting documentation.

Warning : This document is not a European Standard. It is distributed for review and comments. It is subject to change without

notice and shall not be referred to as a European Standard.
EUROPEAN COMMITTEE FOR STANDARDIZATION
COMITÉ EUROPÉEN DE NORMALISATION
EUROPÄISCHES KOMITEE FÜR NORMUNG
CEN-CENELEC Management Centre: Rue de la Science 23, B-1040 Brussels

© 2020 CEN All rights of exploitation in any form and by any means reserved Ref. No. prEN 17500:2020 E

worldwide for CEN national Members.
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Contents Page

European foreword ...................................................................................................................................................... 4

Introduction .................................................................................................................................................................... 5

1 Scope .................................................................................................................................................................... 8

2 Normative references .................................................................................................................................... 8

3 Terms and definitions ................................................................................................................................... 8

4 Organizational and technical processes ............................................................................................... 15

4.1 Organization, management and resources .......................................................................................... 15

4.2 Personnel — knowledge, skills and numbers .................................................................................... 17

4.3 Ethical principles .......................................................................................................................................... 20

4.4 Health promotion and wellbeing ............................................................................................................ 21

4.5 Assistive devices – systems, technology and related services ...................................................... 22

4.6 Accessibility and the built environment .............................................................................................. 23

4.7 Cleaning, hygiene and infections ............................................................................................................. 25

5 Initial processes, assessment, agreement and documentation .................................................... 26

5.1 Initial assessment of needs ....................................................................................................................... 26

5.2 Agreements and contracts related to the older person .................................................................. 26

5.3 Documentation – plans, agreements, initiatives and results ........................................................ 27

6 Main processes – Social and community life ....................................................................................... 29

6.1 Rights, diversity, integrity and participation ..................................................................................... 29

6.2 Security and safety ....................................................................................................................................... 30

6.3 Communication and information ............................................................................................................ 31

6.4 Activities .......................................................................................................................................................... 32

6.5 Informal caregivers – people close to the older person and volunteers .................................. 33

7 Main processes – Health and wellbeing ................................................................................................ 34

7.1 Health literacy ................................................................................................................................................ 34

7.2 Assessment of care during ongoing care .............................................................................................. 35

7.3 Cognitive function and mental health ................................................................................................... 36

7.4 Food, drink, meals and nutrition ............................................................................................................ 37

7.5 Oral and dental health................................................................................................................................. 39

7.6 Bladder and bowel function ...................................................................................................................... 39

7.7 Personal care, skin and wounds .............................................................................................................. 40

7.8 Pain .................................................................................................................................................................... 41

7.9 Medications ..................................................................................................................................................... 41

7.10 End of life and palliative care ................................................................................................................... 43

8 Quality assurance ......................................................................................................................................... 44

8.1 Systematic quality work ............................................................................................................................. 44

8.2 Quality statement ......................................................................................................................................... 45

8.3 Quality management systems .................................................................................................................. 46

8.4 Suggestions and complaints ...................................................................................................................... 47

8.5 Prevention and management of risks ................................................................................................... 47

8.6 Non-conformities and adverse events ................................................................................................... 48

8.7 Evaluation of processes, activities and outcomes ............................................................................. 49

8.8 User feedback ................................................................................................................................................. 50

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8.9 Internal audits ............................................................................................................................................... 51

8.10 Self-assessment ............................................................................................................................................. 51

Annex A (informative) The integrated care concept, healthcare and social care .............................. 53

Annex B (informative) Needs, wishes, assessment and assessment tools ............................................ 56

Annex C (informative) Compliance with requirements and recommendations ................................. 60

Bibliography ................................................................................................................................................................. 62

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European foreword

This document (prEN 17500:2020) has been prepared by Technical Committee CEN/TC 449 “Quality of

care for older people”, the secretariat of which is held by SIS.
This document is currently submitted to the CEN Enquiry.
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Introduction
Values and the development of care

The population of older persons in Europe is increasing, as is the number of older persons who require

care services. Most of the older persons are living at home and only a minority is cared for in care

homes.

Older persons are generally defined according to a range of characteristics including chronological age,

change in social role and changes in functional abilities. In high-resourced countries older age is

generally defined in relation to retirement from paid employment and receipt of a pension.

There is a need for a shift in the way societies are organized and a change in the way older persons and

ageing in general are perceived. Building on the concepts of active ageing and age-friendly

environments, this document, Quality of care for older persons, stresses the importance of enabling the

older person in need of care to be involved and empowered to decide how their needs, expectations and

preferences can be met to live as autonomously as possible.

This document promotes the idea that the older person has the right to age in dignity, to be respected

and to be included as a full member of society. Promoting a rights-based approach means, for example,

fighting age discrimination, protecting service users’ rights, ensuring access to reliable and

comprehensive information, promoting a more accessible environment, and support for mobility,

communication, consultation and participation.

Accessibility and availability of care services also play a critical role in ensuring the inclusion of the

older person. This means that the older person can use a service regardless of age, illness, disability or

functional limitation.

Important factors in quality development are that the older person maintains control over their own life

and that their needs and preferences are considered in the planning and provision of the care. It should

be a priority to develop a person-centred approach in all services, to maintain the dignity, participation

and empowerment of the older person in need of care.
Provision of care need to evolve in radical ways

In most cases, care to the older person is provided in a good way. Despite this, threats to the quality of

care can come from outdated ideas and ways of working, which often focus on keeping the older person

alive rather than on supporting dignified living and maintaining their intrinsic capacity. The older

person may be regarded as a passive recipient of care, and services may be organized around the

service provider rather than the needs and preferences of the older person. Care may focus on meeting

the older person’s basic needs, such as eating, bathing or dressing, at the expense of the broader

objectives of ensuring wellbeing, that life has meaning, and that the older person feels respected.

With these aspects in mind, care ought to evolve in radical ways if the growing needs of older persons

are to be sustainably met. The transformation will require a coordinated and multisectoral response

that involves a wide range of stakeholders, both within and outside governments. The most important

participant being the provider, in the sense that it is the provider who can ensure that the autonomy

and will of the older person are respected. More fundamentally, mindsets about what care might

comprise should be reset. New ways of thinking about integrated care, and the systems for providing it,

need to be developed. All relevant stakeholders need to be responsive, empathetic, proactive and

innovative.

Changes need to encompass two broad areas. First, care needs to be recognized as a public good both

societally and politically. Second, care needs to be redefined. Instead of thinking about care as a minimal

and basic safety net that provides rudimentary support to older persons who can no longer look after

themselves, perceptions need to shift towards a more positive and proactive agenda. Within this new

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framework, care ought to be oriented towards both optimizing intrinsic capacity and compensating for

a lack of capacity to maintain the older person's functional ability and ensures dignity and wellbeing.

New skills and new jobs may be needed. Many jobs are trapped within different conceptual worlds,

either health or social care. Integrated services may enable more flexible and person-centred

approaches where there is mutual recognition and support between different personnel.

An integrated response ensures that the provision of care is optimized

In several European countries, the competencies for health services and social services are divided

between the health and social service systems. Care for older persons are is not considered as a specific

or separate sector of the social security system, and health and social services are not regulated by a

single legal scheme and administered by one single national and/or regional body. Thus, the healthcare

and the social care components of care are provided by different actors, which are registered, evaluated

and operated according to different roles and organizational structures for healthcare and for social

care services. Depending on the degree of integration between healthcare and social care systems, the

care provided to the older person can be managed by one or several providers.

The integration between social care and health care, both administratively and at the points of use, is a

crucial factor in care quality. The strict separation of social care and health care services can result in

fragmented coverage, gaps in the provision of care and inappropriate use of acute services. More and

better coordination is needed at a systems level. See also Annex A (informative).

An integrated response to care covers very different types of care: health care, social care, care for

cognitive diseases, palliative and end-of-life care, services provided at home, in day care centres or in

care homes, public or private-funded, informal care or care by volunteers.

Informal caregivers provide a high amount of care, many of them for their beloved relative. The quality

of life of the informal caregiver is closely linked to the quality of life of the older person in need of care.

Moreover, the provider can facilitate the building of networks with the aim of personnel giving support

to the informal caregivers.

An integrated response to the care needs of the older person is considered, to be the best way to ensure

that the provision of care is optimized and adapted to the needs of the older person.

Health promotion and preventive approaches improve the quality of life of older
persons

Health promotion and risk prevention offer the potential for improving the quality of life for the

growing population of older persons, while reducing the economic burden on the health system.

The World Health Organization describes health promotion as: ‘The process of enabling people to

increase control over, and to improve, their health.” It moves beyond a focus on individual behaviour

towards a wide range of social and environmental interventions.

Health promotion and preventive approaches in care can result in several benefits. It can give the older

person a good and independent life for a longer time. Many accidents, such as fall casualties, can be

avoided. Good and nutritious food, physical activity and strong social networks can help to prevent

illnesses and chronic diseases. Health consultation, counselling and safer treatment with medication are

other ways to prevent health risks among older persons.
How to read and apply this document

This document is intended to be useful to all types and sizes of providers in the private, public, and non-

profit sectors. While not all parts of this document will be of equal use to all types of providers, the

principles are relevant to every provider.

Provision of care consists of processes embedded in complex systems that are inevitably linked to or

require the incorporation of other existing and future standards outside of this document and related to

fields, such as accessibility (of processes, products, and services), ergonomics, social responsibility,

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human resource management, assistive devices and products, sustainable development in communities,

smart homes, cognitive accessibility user interfaces, privacy and data management. This document is an

example of interdisciplinary standardization that has a special focus on care, and it is important that the

provider identifies and incorporates the use of other complementary standards.

This document uses the term ‘care’ for the combination of healthcare services and social care services.

The document aims to facilitate the development of care services by establishing common

denominators that are agreed on as fundamentals of care.

When starting to use this document, each provider identifies the content of their services and hence

which issues are relevant and significant to address.

Establishing quality of care for older persons requires knowledge, skills and a positive attitude towards

development of the care service. Involvement and engagement of top management is crucial when

implementing quality of care for older persons. When the management is committed and educated in

quality requirements and recommendations, they pass down the knowledge to their personnel and

motivate them to be involved. Good communication helps to create a committed and supportive

atmosphere, and thus has a positive influence on the implementation of this document and continuous

improvement of quality.

The requirements and recommendations given in this document are actions to be taken by the provider.

Requirements and recommendations are listed in Clauses 3 to 8 of this document after the introduction

and explanation of the terminology used. These sections start with short general introductions which

provide a brief background to the following requirements and recommendations.

This document uses the words ‘general’ and ‘specific’ in relation to requirements and recommendations

in the following way:

• General requirements and general recommendations apply to all care services regardless of

whether they are provided at home or at a care home.

• Specific requirements and specific recommendations apply mainly to care services provided at a

care home but shall/should also be applied to care services given at home when such services are

in the service description of the provider.
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1 Scope

The services specified in this document are health and social care services for older persons provided

by healthcare and social care personnel.
This document:

— specifies requirements and recommendations for services provided to the older person at home

and in care homes, based on the older person's individual needs and preferences to assist self-

determination, participation, and a safe and secure old age.

— specifies requirements and recommendations for systematic approaches regarding the service

provider’s ability to produce a good quality of care and support for the older person.

— covers services irrespective of the legal form of ownership and whether the service is publicly or

privately funded.

— is applicable to care providers, regardless of structure, organization, ownership, size or type of the

care services provided.

— can be used by the service provider at all management levels in the organization to plan, lead,

implement, maintain, evaluate and improve the quality of the service.

— requests the provider to describe the organizations service content in a service description, which

includes for example a statement of purpose and character of the care service, measures for

ensuring the older persons’ wellbeing and security, the ethical principles, the services and facilities

provided, management and personnel in terms of skills and numbers, methods for quality control

and evaluation of the service.

— requests the provider to compare the service description with the content of this document and,

when needed, gives a statement that describes what clauses, requirements and recommendations

that are not in the service description and therefore not applicable to the provider’s services.

— can be used by the provider for internal audits or self-assessment and/or external parties for

certification/accreditation to assess the provider’s ability to meet the older person’s needs and

expectations.
— can be used to provide basic information for procurement and education.
— does not cover standardization of medical devices and clinical guidelines.
2 Normative references
There are no normative references in this document.
3 Terms and definitions
For the purposes of this document, the following terms and definitions apply.
Note 1 to entry: See also Annex A (informative) for additional information.

ISO and IEC maintain terminological databases for use in standardization at the following addresses:

— IEC Electropedia: available at http://www.electropedia.org/
— ISO Online browsing platform: available at https://www.iso.org/obp
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3.1
Ambient Assisted Living
AAL

combination of intelligent systems of assistive products and services, integrated in the preferred living

environment, constituting 'intelligent environments’ to compensate predominantly age-related

functional limitations and support an independent, active and healthy course of life

[SOURCE: European Commission, Digital Single Market, Glossary]
3.2
abuse

single or repeated act or lack of appropriate action which causes harm or distress to an older person or

violates human and civil rights

Note 1 to entry: Abuse may include physical abuse, psychological abuse, sexual abuse, financial exploitation and

neglect. Elder abuse happens everywhere, including at home within the family, at home with services or in care. It

can be intentional or unintentional.
[SOURCE: WeDO: Wellbeing and Dignity of Older people, 2012]
3.3
accessibility

extent to which products, systems, services, environments and facilities can be used by people from a

population with the widest range of characteristics and capabilities to achieve a specified goal in a

specified context of use

Note 1 to entry: Context of use includes direct use or use supported by assistive technologies.

Note 2 to entry: When evaluating accessibility, the three measures of usability (effectiveness, efficiency and

satisfaction) can be important.
[SOURCE: ISO 26800:2011, 2.1, modified]
3.4
adverse event
unintended event that has a negative influence upon healthcare processes
[SOURCE: EN ISO 13940:2016]

Note 1 to entry: In the European Vigilance System, an adverse event is described as: Any untoward medical or

nonmedical event or occurrence, unintended disease or injury or any untoward clinical signs including abnormal

laboratory findings in subjects of care during or shortly after treatment, whether related or not related to the

treatment.
[SOURCE: EN 15224:2016, 3.5.2]
3.5
built environment

external and internal environments and any element, component or fitting that is commissioned,

designed, constructed and managed for use by people

Note 1 to entry: Loose items are excluded because decisions with respect to their location within the built

environment are more likely to be under the day-to-day control of facilities managers and not of those who

commission, design or construct the built environment.
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[SOURCE: ISO 21542:2011]
3.6
care
combination of healthcare and social care
3.6.1
healthcare services

activities undertaken by healthcare personnel that are intended to maintain and improve health,

prevent harm and illness, slow down deterioration of health, and palliate pain and suffering

[SOURCE: 2006/123/EC and Art. 3, 2011/24/EU, modified]
3.6.2
social care services

activities undertaken by social care personnel that focus on help and support in coping with activities of

everyday life

EXAMPLE: Maintaining the home and getting around inside the home, social wellbeing, independence and social

interaction enabling the older person to play a full part in society and support in vulnerable situations such as

dressing, eating, getting in or out of bed or chairs, personal hygiene e.g. bathing or showering and using the toilet

Note 1 to entry: The content of social care varies between the European countries and in some countries, health

and social care are integrated and the tasks of elderly care cannot be separated as healthcare or social care.

Note 2 to entry: Social care also aims to prevent abuse and neglect.
3.6.3
informal care givers

family, and friends that provide care to an older person in need of care. They do not usually have a

formal status and are usually unpaid
3.6.4
integrated care

coherent set of methods and defined processes to integrate care between hospital and primary care,

health and social care, and formal and informal care, as well as public and private care

Note 1 to entry: The aim of integrated care is to design and implement individual care service models, financially

and administratively coordinated with a view to achieving better outcomes in terms of effectiveness and user

satisfaction. The provision of appropriate care at the right moment in the most appropriate setting implies

collaboration in multi-disciplinary teams with the older person in need of care and their informal caregiver when

relevant.
3.7
care home

place of residence for the frail older person who has physical and/or mental disabilities, and who may

require nursing care to perform daily living activities such as assistance with meals, taking a bath,

getting dressed, going to the toilet and taking medication

Note 1 to entry: The facility provides 24-h supervision, nursing care, rehabilitation programmes and social

activities as well as mediating contact with the social environment, including assistance with asserting rights,

justified interests and looking after personal matters.
Note 2 to entry: care homes are often referred to as nursing homes.
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Note 3 to entry: A care home might specialize in certain types of disability or conditions such as dementia.

3.8
clinical guideline

set of systematically developed statements to assist the decisions made by healthcare actors

...

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