Decision Making in Australian Aged Care – Definitions
It’s important to note that decision making, in the Australian aged care context, is multilayered.
A consumer has the right to consent to or refuse treatment of care and services if they have the capacity to make decisions. If a consumer lacks capacity to make decisions for themselves in respect of treatment, a substitute decision maker can make decisions on their behalf.
The Accreditation Standards and The Charter of Aged Care Rights support the right of all consumers, regardless of their capacity to make decisions, to be included in any decision making about their care and services planning and delivery.
There are some key concepts around decision making in residential aged care. The following document outlines Anchor Excellence’s definition of these fundamental terms.
What is Capacity?
Capacity is an older person’s ability to make their own decisions about the care and services they receive, and where and how often they receive this care and service delivery.
If a consumer can understand the information being given to them by their clinicians and use this information to make informed decisions about their care and services, then they have capacity.
Capacity assessment has a number of underpinning principles. These are:
- A consumer has capacity to make decisions about the care and services they receive.
- Each decision a consumer makes is specific to that decision. A consumer decision making capacity can vary from situation to situation. This may depend on the complexity of the decision to be made.
- Assumptions about a consumer’s capacity cannot be based on how a consumer looks, presents or communicates; their level of physical impairment or their behaviour.
- It is the consumer’s decision-making ability that is being assessed, not the decision that they make.
- The consumer has a right to privacy in relation to their personal information.
- Assisted decision making should be encouraged. Assisted decision making means that a consumer may be able to make care and service decisions with a support person to assist them. Appointing a substitute decision maker should only be considered when all other options have been exhausted.
A consumer may have capacity to make simple decisions about their care, whilst not having the capacity to understand the implications of more complex care interventions.
A consumer’s capacity to make decisions about their care and services may change over the time they are receiving care and services from your organisation.
A functional capacity assessment will be one indicator of the consumer’s capacity to make decisions about the care and services they receive.
What is Consent?
Consent is voluntary agreement to receiving care and services. This is important in the context of initial and ongoing care and services planning processes, and medical treatment.
No care and service provision can be provided to a consumer without consent.
To be valid, consent must be voluntarily given and be made after information has been provided and explained.
Consent can be revoked at any time.
Who is an Advocate?
An advocate is an impartial person who upholds a consumer rights, negotiating with the aged care and services provider in relation to care and services planning and delivery. An advocate can present any concerns the consumer has regarding care and services to the organisation.
It is important to note that an advocate is not a decision maker.
Who is a Guardian and Enduring Guardian?
The role of a Guardian and Enduring Guardian is an important one.
A Guardian or an Enduring Guardian is legally appointed when a consumer does not have capacity for ongoing decision making.
Each Australian State and Territory has a Guardianship and Enduring Guardianship framework. For specific information related to your organisations State or Territory Guardianship and Enduring Guardianship provisions, please review the relevant legislation for that State or Territory.
Who is a Power of Attorney or an Enduring Power of Attorney?
The role of a person with a Power of Attorney or Enduring Power of Attorney is an important one.
A Power of Attorney or Enduring Power of Attorney authorises another person to make personal and financial decisions on behalf of a consumer.
Each Australian State and Territory has a legal framework concerning a Power of Attorney and an Enduring Power of Attorney. For specific information related to your organisations State or Territory Power of Attorney and Enduring Power of Attorney provisions, please review the relevant legislation for that State or Territory.
Who is a Nominee?
A nominee is a person the consumer has appointed to communicate with the Australian Government Department of Human Services, concerning a consumer’s financial status.
To be appointed as a nominee, the Aged Care Appointment of a Nominee Form (AC019) must be completed and lodged with the Australian Government Department of Human Services.
This appointment can be revoked at any time by the consumer.
Who is a Representative?
There are two (2) types of representatives.
- A regular representative is appointed by the consumer to speak to My Aged Care on their behalf while the consumer has capacity.
An authorised representative is appointed when there is no longer capacity to speak to My Aged Care.
- To be appointed as a nominee the ‘My Aged Care Appointment of a Representative Form’ must be completed and lodged with The Accreditation Standards and The Charter of Aged Care Rights.
Supporting documentation such as Enduring Guardianship, and Enduring Power of Attorney and a Medical Officer’s letter conceding capacity will be required.
A representative will be given a My Aged Care client number that is used to access My Aged Care on behalf of the consumer.
This appointment can be revoked at any time by the consumer.
Who is a Person Responsible?
Decisions about care and services and medical treatment can be made for a consumer who does not have the capacity to make decisions by a nominated person. In New South Wales, for example, this person is called the Person Responsible.
A Person Responsible does not have to be the consumer’s next of kin.
The New South Wales Guardianship Act 1987 provides a hierarchy to help determine who the Person Responsible is. The hierarchy is as follows:
- An Enduring Guardian or a Guardian appointed by the NSW Guardianship Tribunal.
- A spouse or de facto partner in an ongoing relationship.
- An unpaid carer who provides ongoing care on a regular basis.
- A close friend or close relative.
Each Australian State and Territory has a legal framework concerning a Person Responsible or similar title. For specific information related to your organisations State or Territory Person Responsible or similar title provisions, please review the relevant legislation for that State or Territory.
Who is a substitute decision maker?
A substitute decision maker makes decisions for the consumer when the consumer no longer has capacity to make a particular decision for themselves.
A substitute decision maker does not have to be the consumer’s next of kin.
What is supported decision making?
Supported decision enables people with a cognitive impairment to be involved in making choices and decision making about the care and services they receive in residential aged care.
Supported decision making also enables the consumer to communicate these choices and decisions about the care and services they want to receive and the risks they want to take.
Supported decision making includes the use of prompting, encouraging and providing some ideas for the consumer to consider when making a supported decision.
If more support is needed a substitute decision maker is appointed.
For More Information
Go to your organisations policy and procedures
Aged Care Quality and Safety Commission (2019) The Aged Care Quality Standards
Australian Government Aged Care Quality and Safety Commission (2019) The Charter of Aged Care Rights
Australian Government The Aged Care Act 1997 and Principles
Your State or Territory Guardianship and Trustee agency
My Aged Care www.myagedcare.gov.au