SIST-TS CEN/TS 17500:2022
(Main)Quality of care and support for older persons
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
V tem dokumentu so določene storitve zdravstvene in socialne oskrbe za starejše, ki jih izvaja zdravstveno in socialno osebje. Ta dokument:
– določa zahteve in priporočila za storitve, ki se izvajajo za starejše v njihovem domačem okolju in domovih za ostarele na podlagi individualnih potreb oziroma preferenc glede samostojnega odločanja, sodelovanja ter varnosti v starosti;
– določa zahteve in priporočila za sistematične pristope v zvezi s sposobnostjo izvajalca storitev, da starejšemu zagotovi kakovostno oskrbo in podporo;
– zajema storitve ne glede na pravno obliko lastništva in ne glede na to, ali se storitev financira javno ali zasebno;
– se uporablja za izvajalce oskrbe, ne glede na strukturo, organizacijo, lastništvo, velikost ali vrsto storitev oskrbe;
– lahko izvajalec storitev uporablja na vseh ravneh upravljanja v organizaciji za načrtovanje, vodenje, izvajanje, vzdrževanje, vrednotenje in izboljšanje kakovosti storitve;
– lahko izvajalec uporablja za notranje presoje ali samoocenjevanje oziroma ga lahko uporabljajo tretje osebe za certificiranje/akreditacijo in tako ocenijo sposobnost izvajalca, da lahko zadovolji potrebe in pričakovanja starejšega;
– je mogoče uporabiti za zagotavljanje osnovnih informacij za namene preskrbe in izobraževanja;
– ne zajema standardizacije medicinskih pripomočkov in kliničnih smernic.
General Information
Standards Content (Sample)
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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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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