This month, at 96 years of age, Queen Elizabeth II passed away. There were noticeable changes in the Queen's health prior to this; over the past year or two, her health had steadily declined, with her mobility affected and illnesses impacting her more.

In our last post, we highlighted the changes that can alert you to the deterioration of a person living in their own home.

If we are diligent in following up on those signs and if issues are addressed in a timely manner, it usually means the person is able to remain living at home for much longer, just like Queen Elizabeth II did.

Indeed, the ability for people to access quality home care support in Australia has resulted in people now being much older when they finally enter residential care. They often have comorbidities (more than one health condition or disease) and have complex care needs.

Due to these factors, it is important for care staff to be alert to signs of deterioration in people living in residential care facilities.

Older man sitting on the edge of his bed with his hand on his back. Text reads: Noticing when something "isn't quite right..."

The changes can be slight but will be noticeable to staff who care for each person consistently and get to know their “usual self”.

Person-centred care focuses on building trust and partnering with the resident to provide the care that is important to them. No two people are the same. Everyone has their story to tell and their lived experiences that have shaped them. The more you know about a person, their routines and preferences – as well as their physical and mental state – the better you are able to pick up when something changes or when something is not right.

If you’re alert, you'll notice when a person is not walking as well and needs to sit and rest more often, perhaps they’re more out of breath than usual.

Or when a person doesn't finish their meals or requires additional assistance to finish them or they start to say things like, “I'm not hungry, leave me alone.” If you pick up on this quickly, you might avoid the next indicator – loss of weight.

Furthermore, the staff might note that a resident is experiencing more falls, they may have increased trips to the hospital, a sudden change in habits or a lack of care in general and in their appearance.

It is essential to report these signs; otherwise, the resident may miss out on the care and support they need.

Signs of change

Palliative Care Australia identified three common illness trajectories for people with a life-limiting illness, depending on their primary diagnosis.

  • A short period of evident decline – these residents may have good function for a long period followed by a few weeks or months of rapid decline before death.
  • Long-term limitations with intermittent serious episodes – these residents will gradually decline in function. During each acute episode, the resident is at risk of dying, but they may not. However, the function will continue to decline.
  • Prolonged dwindling – the resident has a long-term progressive disability and reduction in function. Death may be caused by infections, falls, or fractures.

Reflect on your experience working in residential aged care and think about people you have cared for that may fit into one of these trajectories.

Regular reviews

No matter what trajectory residents are on, most people living in residential care will need regular reviews of the care and supports they receive against their assessed needs. Their requirements are always changing and every step of the way it is necessary to consistently evaluate the effectiveness of services to ensure they meet the person’s needs.

Many tools are available to support clinical assessment. If you use an electronic care system or client management system (CMS) it may have these built into the system. Make use of them!


One observation tool used by staff and some palliative care organisations is the “Stop and Watch” tool.

The Stop and Watch tool is used when someone is not their usual self. It helps care staff identify the warning signs of deterioration.

S – Seems different than usual
T – Talks or communicates less
O – Overall needs more help
P – Pain: new or worsening, participated in fewer activities

A – Ate less
N – No bowel movement for three days
D – Drank less

W – Weight change
A – Agitated or nervous more than usual
T – Tired, weak, confused or drowsy
C – Change in skin colour or condition
H – Help with walking, transferring and toileting more than usual

Florida Atlantic University (2011)

What should you do?

  • Use the Stop and Watch tool or other tools you have access to if you notice that something is ‘just not right’.
  • Escalate the issue to the relevant person in your team and clearly document when and what you notice about the person that impacts their health and wellbeing.
  • Respond appropriately to the person’s assessed needs.
  • Where possible, always involve residents in their care and choices and ensure their wishes are met.
  • Involve the Enduring Power of Attorney and family in their loved one's care and choices.
  • Ensure you have the support of services involved when a person is deteriorating; check your local state or territory PNU, hospital, palliative care, or any other help that is available in your area. Ensure the contact details are available for staff 24/7. Remember, wherever you are, there is always support.
  • Check that all residents have an advanced care plan (or similar) to ensure a resident's wishes are followed and honoured for their request.

Education and training

All staff need to have the skills and knowledge required to identify deterioration in a person.

Senior staff need to mentor and support new or less experienced team members in developing their skills in observation so that noticing changes in a resident's declining health becomes second nature.

If all people living in residential care are supported by observant, knowledgeable and caring staff, their final days can be fulfilling, just as the Queen had a team of people around her to provide care and support to her in her final months, allowing her to live life to the end. And that’s what we hope for all people no matter where they spend their final days.

Thank you for your devotion to caring for our residents and giving them the best possible life and care that every person has the right to receive every step of the way.

If you can think of someone else who might benefit from this article, send them a link. We’d appreciate it! And if you’re looking for more helpful resources, why not check out our Total Quality Package resource hub? We have culturally appropriate, tailored resources that are designed to make your job simpler and help you provide quality care to your clients. Click here to find out more.

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