How many of your consumers have advance care directives?

As well as being important for ongoing coordinated care that supports consumers’ choices and decisions, Advance care planning is an important part of a coordinated response to pandemics such as COVID-19 (Australian Health Management Plan for Pandemic Influenza 2019).

Current research demonstrates that only 25% of older Australians aged 65+ years have an Advance Care Directive/Plan. Despite this, individuals often report benefits in doing advance care planning. 

Advance Care Planning Australia (ACPA) provides the following advice to healthcare providers and sectors across Australia, which is likely to be updated regularly, so please return to this page for the latest information. 

Advance care planning priorities for aged care providers

ACPA is urging aged care providers to include advance care planning in their management of COVID-19.

Aged care providers have obligations under Aged Care Quality Standards 2, Requirement (2)(b) assessment and planning identifies and addresses the consumer’s current needs, goals and preferences, including advance care planning and end of life planning if the consumer wishes.

ACPA recommends aged care providers encourage aged care consumers with decision making capacity to: 

  • think about and discuss their future health care preferences with loved ones and their treating medical practitioner
  • identify their substitute decision-maker(s). Appoint these when relevant and make this known to their treating medical practitioner or service
  • make existing Advance Care Directive documents available and store in their health record
  • document their preferences and acceptable / unacceptable outcomes (e.g. CPR, ventilation, loss of independence) in an Advance Care Directive.

In addition, ACPA recommends the aged care workforce and providers: 

  • identify and assist high-risk patients who may want less treatment, to document these preferences in an Advance Care Directive, service care plan and/or medical order
  • if conducting a COVID-19 telehealth advance care planning consultation, documents can be completed and signed with the use of email or fax
  • enter the individual’s substitute decision-maker details and/or Advance Care Directive into the health record for transfer between care providers. 

COVID-19 restrictions create difficulties in getting Advance Care Directives signed by the appropriate people. Advance Care Directives can be completed with the use of email or fax. Alternatively, all states and territories (excluding Queensland) recognise common law Advance Care Directives which can be created by using a recommended form or creating a letter, and should include the person’s:

  • name
  • date of birth
  • preferences for care
  • acceptable or unacceptable outcomes (e.g. CPR, ventilation, loss of independence)
  • substitute decision-maker
  • signature and date.

These preparations will support service providers in being able to offer appropriate, quality care to consumers.

These can be confronting and difficult conversations. At Erigo, we strongly encourage you to have specific staff trained to have these conversations with consumers at the beginning of their aged care journey, and review them as their health status changes, keeping in mind the consumer must have decision-making capacity to make changes. Substitute decisionmakers must make the medical treatment decision that they reasonably believe to be the decision the person would have made if they had decisionmaking capacity.

Resources for providers

The National Advisory Services 1300 208 582, 9am – 5pm, Monday – Friday (AEST) and/or ACPA Learning hub.

Advance Care Planning Australia offers training webinars here: https://www.advancecareplanning.org.au/for-health-and-care-workers/covid-19-web#/

Advance care planning in aged care: A guide to support implementation in community and residential settings

References:

  1. Advance Care Planning, accessed 17/4/2020 – https://www.advancecareplanning.org.au/for-health-and-care-workers/covid-19-web#/

What are your thoughts?