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The deteriorating resident: a guide for facility leadership

Facility leadership Aged care staff 6 min read

By Dr Josh Hatch, FRACGP

Recognising and responding to a deteriorating resident is a system, not one person’s skill. The strengthened Quality Standards place it in Outcome 3.2, with escalation in Outcome 3.3, and require an antimicrobial stewardship system under Outcome 5.2 1. The wording below is from the November 2025 version, implemented on 1 November 2025; the Standards and their guidance change 1.

Numbers in the text link to the 13 sources listed at the foot of this page.

What the Standards require

  • Action 3.2.5. Strategies that support workers to recognise risks, identify deterioration or changes in a person’s daily function, mental health, cognition or physical condition, and respond and escalate in a timely way 1.

  • Action 3.2.4. Timely and appropriate referrals to support early identification and intervention 1.

  • Outcome 3.3 and Action 3.3.3. Changes and deterioration escalated and communicated, with processes for residents, their supporters and registered health practitioners to escalate concerns 1.

  • Actions 5.4.2 and 5.4.5. Planning for clinical risks, acute conditions and exacerbations of chronic conditions, and reassessment when there is deterioration and at transitions of care 1.

  • Outcome 5.2. An antimicrobial stewardship system that complies with contemporary evidence-based practice, and processes for clean and aseptic procedures, for using and reviewing invasive devices including urinary catheters, and for minimising transmission of infection 1.

Reading the hospitalisation indicator

The hospitalisation indicator counts the percentage of residents with one or more emergency department presentations, and with one or more presentations or admissions, each quarter. It includes virtual emergency department presentations and admissions to hospital in the home 6. The national trend in both measures rose significantly to the end of 2025 7.

A falling rate is good news only if residents who need and want hospital still get there. It is worth reading alongside goals-of-care documentation, deaths, complaints and family feedback.

Questions for a governance meeting

  • Do care workers know what to report?. A change in eating, mobility, behaviour or alertness, and do they feel able to report it 12?

  • Are baselines recorded?. Is each resident’s usual thinking, mobility, eating and observations written where a night nurse can find them?

  • Is there a structured call format?. Is ISBAR or a similar format used, and is it checked 2526?

  • Do after-hours staff have the numbers?. The GP, the after-hours service, any local hospital outreach line, and the facility’s rule for calling 000 2732.

  • Are goals of care current and easy to find?. Including on the transfer paperwork that goes with a resident to hospital.

  • What does the antimicrobial data show?. Does the facility take part in AC NAPS, and are indications and review dates documented 5?

  • Are urine tests driven by symptoms?. Or by confusion, smell or routine 4?

Facility-wide programs: what has been tested

Graded on randomised evidence in nursing homes.

Acute-change toolkit training (INTERACT)

Not supported

No change in admissions or emergency visits.

The evidence

85 US nursing homes, 36,717 residents 11.

Implementation program for an early warning score (NEWS2)

Uncertain / conflicting

More use of the score; resident outcomes not measured.

The evidence

21 Norwegian nursing homes 10.

Urinary infection algorithm with education

Promising, not yet proven

Fewer antibiotic courses with no rise in admissions or deaths.

The evidence

24 nursing homes in Canada and the US 17.

Related pages on this site

Sources cited on this page

  1. 1 Australian Government Department of Health, Disability and Ageing. Strengthened Aged Care Quality Standards (November 2025; implemented 1 November 2025). Outcome 3.2, Actions 3.2.4 and 3.2.5; Outcome 3.3, Action 3.3.3; Outcome 5.2, Actions 5.2.1 and 5.2.2; Outcome 5.4, Actions 5.4.2 and 5.4.5. View source
  2. 2 Australian Commission on Safety and Quality in Health Care. Sepsis Clinical Care Standard. Sydney: ACSQHC; June 2022. (Primary settings are ambulance services, hospitals and urgent care centres; also listed as relevant to aged care homes and general practice.) View source
  3. 4 Australian Commission on Safety and Quality in Health Care. Guidance for implementation of the Antimicrobial Stewardship Clinical Care Standard in aged care. Sydney: ACSQHC; November 2024. View source
  4. 5 Australian Government Department of Health, Disability and Ageing. Infections and antimicrobial prescribing in Australian residential aged care homes: results of the 2023 Aged Care National Antimicrobial Prescribing Survey. Canberra; 2025. (Prepared by the Royal Melbourne Hospital and the National Centre for Antimicrobial Stewardship; 852 homes, 53,843 residents; point-prevalence survey.) View source
  5. 6 Australian Government Department of Health, Disability and Ageing. National Aged Care Mandatory Quality Indicator Program: quick reference guide, hospitalisation. (Undated; published October 2025.) View source
  6. 7 Australian Institute of Health and Welfare, GEN Aged Care Data. Residential aged care quality indicators — October to December 2025 (released 23 April 2026; 2,575 homes; trend analysis over 18 quarters from July–September 2021). Reported quarterly; later quarters are published on the same page. View source
  7. 10 Graverholt B, Espehaug B, Ciliska D, Potrebny T. The effectiveness of a knowledge translation intervention on the implementation of NEWS2 in nursing homes, a pragmatic cluster RCT. Implement Sci. 2024;19:64. (21 Norwegian nursing homes; outcome was use of NEWS2, not resident outcomes.) View source
  8. 11 Kane RL, Huckfeldt P, Tappen R, et al. Effects of an intervention to reduce hospitalizations from nursing homes: a randomized implementation trial of the INTERACT program. JAMA Intern Med. 2017;177:1257–64. (85 US nursing homes, 36,717 residents.) View source
  9. 17 Loeb M, Brazil K, Lohfeld L, et al. Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial. BMJ. 2005;331:669. (24 nursing homes in Ontario and Idaho; 4,217 residents.) View source
  10. 25 Müller M, Jürgens J, Redaèlli M, Klingberg K, Hautz WE, Stock S. Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. BMJ Open. 2018;8:e022202. (Eight before-and-after studies and three controlled trials, including nursing homes.) View source
  11. 26 Aged Care Quality and Safety Commission, resource library. ISBAR: Identify, Situation, Background, Assessment and Recommendation. (Undated; listed as a state or territory resource, not a Commission publication.) View source
  12. 27 Healthdirect Australia. Calling triple zero (000). (Last reviewed August 2025.) View source
  13. 32 Queensland Health. RaSS telephone triage contacts for registered nurses, clinical managers and GPs. (Last updated 20 April 2022.) View source

See every source cited across the deteriorating resident section →

Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at November 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment, and it does not set escalation rules for any facility. Antibiotic choices and doses follow current prescribing guidelines and local advice. Evidence, Australian regulatory requirements and local services change — always confirm current advice with the treating GP and the facility’s own procedures.

This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.

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