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Comparison Table on the Accreditation System of Nursing Home for Elderly
(Australia, United Kingdom, Canada & United State)
There are different terms used in the quality assurance practice of different counties, the term “accreditation” is used in Australia, Canada and United States, “Care Standard” is used in United Kingdom.

Country / Australia United Kingdom
Items
Operating Agency Aged Care Standard and Accreditation Agency,
a commissioned body of government Commissions for Care Standards, an independent statutory bodies within the Social Care Policy Division of the Department of Health
Purpose 1. ensure NHs to operate in accordance with the legislative
requirements
2. ensure NHs to provide high quality care within a framework of continuous improvement 1. provide minimum standards of service
2. protection of service users; safeguard and promote their
health, welfare and quality of life
Nature Compulsory, statutory requirement Compulsory, statutory requirement
Focus Outcome and Process Outcome and Process
Contents Four standards with 44 outcomes
A Management systems, staffing and Organizational
development

B Health and Personal Care

C Resident Lifestyle

D Physical Environment and Safe
System

A Choice of Home(standards1-6)
(1) Information, (2) Contract, (3) Needs assessment,
(4) Meeting Needs, (5)Trial Visits, (6) Intermediate Care

B Health and Personal Care (Standards 7—11)
(7) Service User Plan,(8) Health Care, (9) Medication,
(10) Privacy and Dignity, (11) Dying and Death

C Daily Life and Social Activities(Standard12 –15)
(12)Social Contact and Activities, (13) Community Contact,
(14) Autonomy and Choice, (15) Meals and Mealtimes
D Complaints and Protection(Standards 16-18)
(16) Complaints, (17) Rights, (18) Protection
Process and Means of accreditation 1. Desk audit -- An assessment of the application, supporting documentation and other relevant information (eg. Complaints history and confessional resident ratio)

2. On sit audit -- observation, discussion with staffs and residents

3. Notify services units the accreditation decision 1 Discussion with families and friends, staff and managers
2 observation of daily life in the home
3 scrutiny of written policies, procedures and records

( No clear procedure has yet been set )

Power All services units must obtain accreditation to receive Commonwealth government funding No service units can be operated without meeting the minimum standards




Country /
Canada United States
Items
Running Agency Canadian Council on Health Service Accreditation, a non-profit and non-governmental organization In dependent and non-profit organizations

Joint Commission on Accreditation of Healthcare Organization (JCAHO)

Continue Care Accreditation Commission (CCAC)

Purpose Quality Assurance Quality Assurance
- encourage service units to continuous improvement on safety
and quality of care provided to the public

Nature Voluntary
- It is not a service governing system. But more focus on the striving spirit of better quality services from the participating institutions. The participation is absolutely voluntary. Institutions received award will be rewarded with monetary subsidy Voluntary

Focus Structure, process and outcome
 stressed on team approach and client centered care Process and outcome

Content Client care and the delivery of service, information management practices, human resources development and management, the organization's governance and the management of the environment.

The accredited status is determined by:
1. Level of compliance with CCHSA’s national standards
2.Demonstration of quality improvement initiatives
3.Management of risk


( no detail standards information available on-line )
36 performance areas and 450 standards involved
A Resident Rights and organization Ethics
1. Resident rights 2. Organization ethics

B Continuum of Care
3. Continuum of care

C Assessment of Residents
4. Assessment 5. Diagnostic Service

D Care and Treatment of Residents
6. Planning and providing care 7. Medication
8. Nutrition Care 9. Rehabilitation care and services
10. Rehabilitation Care and Service 11. Care of the dying
12. Special procedures 13. Respiratory care services for
subacute programs 14. Anesthesia care services for
subacute programs

E Education of Residents
15 Education on residents

F Improving Organization Performance
16 Design of new services 17. Measure of processes and
outcome 18. Assessment of data 19. Improvement of
performance

G Leadership
20. Planning and designing services 21. Directing services
22. Integrating and coordinating services
23. Leaders’ role in improving performance

H Management of the Environment of Care Design
24. Design of the environment 25. Implementation of safety
plans 26. Measurement systems 27. Social environment

I Management of Human Resources
28. Human resources planning 29. Orientation,
training, education and competency of staff
30. Credentialing 31.Privileging for subacute Programs

J Management of Information
32. Information management planning 33. Availability of
resident information 33. Use of information
34. Comparative information

K Infection Control
35. Infection control

L Accreditation Participation Requirements
36. Accreditation participation requirements
( only information of performance areas but no information of
standards )
Process and Means of accreditation 1. Self assessment
2. The Pre-Survey process -- documentation, data, analysis, interpretation and communication required for an organization's activity and performance information.
3. On site visit – discussion with staff, clients/patients and the Organization's community stakeholders, tours the settings and looks at documents and client/patient/resident records to Support their observations
4. Notify the accreditation result
 Characteristics : Usually the surveying time is about 1 week. Accreditators are usually come from other provinces so that cheating possibilities are minimal.
The surveyor(s) may spend several days at the organization observing activities, interviewing patients/residents and staff, and reviewing documents. The surveyor(s) spends a significant amount of time on patient/residents units, observing services as it is carried out.
 Characteristics : Random Unannounced Survey to check the performance between surveys
Power --- ---


General Comments
1. The purpose of accreditation can categorized as ensuring minimum standard and quality assurance.
 For Australia and UK, the accreditation is mandatory and is aimed for ensuring a minimum standard of service. In Australia, the system stresses on the concept of continuous of improvement whereas in UK the purpose of accreditation is actually part of the licensing procedure.
 For US and Canada, the accreditation is voluntary and the aim is for Quality assurance.

2. Although different terms might be used, the contents of accreditation can be broadly categorized into four aspects :
- management and administration
- resident’s lifestyle
- health care
- environment.

3. Probably because of the difference in aims and nature, it gives us an impression that the Australian system is quite similar to the SQS we now have. Since we do not have the contents of the Canadian Accreditation system at hand, we cannot compare (One of my friends in Canada is trying to get me a copy). But according to a practitioner in Canada, their system is ore focus on the striving spirit of better quality services and this gives a more positive image to the system. The Australian system requires certain items to present, the one in Canada not only requires such item to exist, but require the homes to provide the service in good quality. The following are some examples to illustrate :



Item/Country Australia Canada
Planning and Leadership (AUS)/
The organization governance; human resources development (CA)
-- Mission, direction The organization has documented the residential care service’s vision, philosophy objectives and commitment to quality throughout the organization Emphasizes on the strategic direction development, review and progress evaluation and how can other fiscal, human education resources support the direction.

Recruitment Appropriately skilled and qualified staff sufficient to ensure that services are delivered in accordance with these standards, and the residential care service’s philosophy and objectives
- clear job description, recruitment process, performance review, and disputes management
Emphasizes on comprehensive human resource plan with reference to financial utilization and human resources data
How recruitment criteria match with evolving care need of residents.
Partnership with education organization to improvement recruitment and retention strategies
Health and Personal Care(AUS)/
Client Care and the delivery of service (CA)
--Comprehensive Assessment Proper nursing care need Emphasizes on interdisciplinary collaboration and interdisciplinary team assessment
Physical environment and safe system (AUS) /Management of Physical Environment(CA)
--Fire, security and other emergencies
Management and staff are actively working to provide an environment and safe systems of work that minimize fire, security and emergency risks.
- clear instruction on emergencies, staff orientation in fire safety, maintenance of equipment, fire/emergency drills Emphasizes on the quality of service and collaboration with the community, such as agreements with other long term care facilities for support, procedure in helping wandering case in evacuation.

Infection Control An effective infection control program
-reporting mechanism, identification of sources, maintenance of equipment Emphasizes on prevention procedure, education to staff.