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Nearly a third of Advance Care Directives are invalid

A nationwide study from Advance Care Planning Australia (ACPA), a national program empowering consumers to prepare for important healthcare decisions in the future, has found nearly a third of Advance Care Directives (ACDs) audited in residential aged care facilities around the country were invalid.  

Without an Advance Care Directive, Advance Care Planning Australia says they will always be confusion for aged care staff, families and health care providers. [Source: Shutterstock]
Without an Advance Care Directive, Advance Care Planning Australia says they will always be confusion for aged care staff, families and health care providers. [Source: Shutterstock]

The research uncovered 30 percent of ACDs of residents in nursing homes had been completed by another person, such as a family member, on behalf of a person that was no longer competent.

Of those documents, around 68 percent had instructions for withholding life-sustaining treatment, like tube feeding or intravenous antibiotics.

Program Director of Advance Care Planning Australia, Linda Nolte, explains that advance care planning is incredibly important for older Australians to continue living their life on their own terms as they grow older.

Ms Nolte says, “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.

“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’s research has found that advance care planning is very low in Australia, with 75 percent of people aged 65 and over not completing an Advance Care Directive.

This number is similar for residents in nursing homes with 62 percent of residents over 65 not having a completed ACD on their health record.

ACPA believes that with such a large ageing Australian population, there is a growing expectation that people will continue to make their own medical choices well into their senior years.

ACPA has released ten recommendations to improve awareness of the importance of ACDs.

They include:

  • Awareness strategies to encourage the uptake of advance care planning.

  • Legally-compliant advance care planning practice that ensures ACDs are only completed by the individual for themselves when they still have capacity.

  • Increased support and education to help aged care and health service providers better understand advance care planning legislation and requirements.

  • A system-wide, multifaceted approach to better support the ageing population to understand, complete and review ACDs before loss of capacity and/or admission to residential aged care.

  • Sustainable investment in Advance Care Planning Australia 

  • Individuals who do not have decision-making capacity and have not developed an Advance Care Directive maintain personal choice and control by having the identified substitute decision-maker involved in their medical treatment decisions 

  • Review of the National Framework for advance care planning and more consistency in advance care planning legislation

  • More widespread implementation of the Advance care planning in aged care: A guide to support implementation in community and residential settings guide from ACPA

  • Aged care services encourage use of My Health Record to enable storage, transferability between services and accessibility

  • Ongoing promotion, resources and research to support the unique needs of culturally and linguistically diverse groups, members of the LGBTQI community, people living with a disability, and other diverse groups within aged care.

Since many older people within nursing homes could develop or have a range of neurological related diseases, it can be difficult for an individual to continue making medical choices for themselves.

An Advance Care Directive is a legal document explaining a person’s future health care decisions, end of life care, residential or living arrangements and any other personal matters you want to implement when you are no longer able to make these decisions yourself.

The document only comes into effect when a person no longer has the capacity to make medical decisions for themselves.

However, ACPA says ACDs are only legal when completed and signed by a person with decision-making capacity.

This could leave many aged care residents at risk of not receiving the medical treatment they wanted or stop treatment that did not want to receive.

Without an Advance Care Directive, ACPA says they will always be confusion for aged care staff, families and health care providers.

For more information, head to the Advance Care Planning Australia website.

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