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End-of-life risk for aged care

Almost a third of Advance Care Directives (ACDs) audited in Australian residential aged care facilities were found to be invalid following a nation-wide study.


05 Dec 2019

Research led by Advance Care Planning Australia revealed that 30% of ACDs in residential aged care had been completed by someone else (usually family members) on behalf of a non-competent person. Unsettlingly, 68% of those documents included instructions for withholding life-sustaining treatment such as tube feeding or intravenous antibiotics.

With a rapidly ageing Australian population, there’s a growing community expectation that people will continue to make their own medical treatment choices well into their senior years. Consumer dignity and choice was identified as the foundation quality standard by the Aged Care Quality and Safety Commission in July this year, highlighting a person’s right to make informed choices about their own care.

An Advance Care Directive is a legal document outlining a person’s preferences and instructions for their future health care. The document comes into effect when a person is no longer capable of making their own medical decisions, providing a sense of certainty, choice and control in the face of declining health. However ACDs are only legal when completed and signed by person with decision-making capacity.

This oversight potentially leaves aged care residents at risk of being denied access to medical treatment that they would have wanted, or given treatment they would have preferred to avoid. The ambiguity also creates risk and confusion for aged care staff, families and health care providers.

ACPA has released ten recommendations in a position statement to strengthen the rigour and validity of ACDs and support the aged care sector in delivering legally-compliant and ethically-sound advance care planning.

“Advance care planning offers the best chance for us to live life on our terms, as we grow older. However where a person has dementia or lacks decision-making capacity, advance care planning needs to be navigated carefully and in full adherence of the relevant governing laws, which differ from state to state,” explained Linda Nolte, Program Director of ACPA.

“These findings underscore a broader societal issue that advance care planning needs to start earlier, before people enter care and ideally when they’re well enough to make their own decisions. For many aged care residents entering care, it’s too late to start advance care planning. We urge Australians to plan well, plan early and involve those closest to you.

“ACPA recognises that the aged care sector is under pressure and needs support to ensure ACP is well-coordinated, delivered respectfully and within legal frameworks. We’re here to help with a range of free resources including online training for staff, access to legal forms and resources, and our National Advisory Service (1300 208 582) which operates Monday to Friday,” commented Ms Nolte.

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