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The nation's top advocacy group for older people has called for new laws to give aged care residents more power over the care they receive.
The Older Persons Advocacy Network (OPAN) released a position paper last week highlighting how substituted decision-making can lead to the abuse and neglect of older people.
OPAN's chief Graig Gear said it's a fundamental right that older people, like all adults, are allowed to make decisions about the care and services they want.
Join Aged Care Insite's conversation with Gear about how Australia can safeguard older people by giving them a voice in the care they receive.
ACI: What are currently the laws around substitute decision-making regarding older people and aged care?
GG: We're living in a society that assumes older people don't have the capacity to make decisions about their life. We must retrain the system to think about older people's daily decisions and ensure their wishes and preferences are reflected and heard.
So, occasionally, there'll be times when an older person needs or wants to have a substitute decision-maker. However, that will usually be for minimal decisions in their life, such as medical or financial decisions, when they can't communicate. These instruments should only be used as a last resort. And even when these instruments are in place, people should still be working with the older person to record their wishes and preferences. You always have to work with the older person to take their direction.
So, what issues does OPAN have around substitute decision-making?
There's a multitude of issues at the moment and misunderstanding. We end up saying that either providers or family members, by default, have a power of attorney in decision-making for an older person. But, then, this also happens when that person is still able to communicate and make decisions for themselves.
We also see cases where the older person has previously expressed their preference, for example, about the treatment they want or what type of care they want. But, there are times that preference is completely overwritten by the family member or by sometimes the provider as well. So, it's making sure older people are understood and protected and that we always assume that they've got the capacity to make those decisions for themselves.
Who do you hope this report will influence? And what do you hope it will achieve?
We're looking for this report to start a conversation about a framework of supportive decision-making. And what role decision-making has in the way we interact with older people in daily interactions and deliver care. In the framework, we should put in place measures to protect the most vulnerable at the centre. We want the government and aged care providers to think about why they're representing older people, how they interact and how they're supporting people to take charge of their own decisions — and so calling on a national framework to be implemented in legislation to require that to happen.
And do you think there has been an overall improvement or progress in this issue over the past years?
There's been a number of policy documents, frameworks and talks. It's mainly for the supported decision-making tool kit. But it needs to be in daily practice if care is delivered. Under our framework, there's a good decision-making model that would work. We need to fund and train people to use these tools and get them used to the game.
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I agree that often children or younger relatives are making later life decisions for the older members of their families without consultation or agreement of the older person on their care options. Sadly, it is difficult to ensure this does not happen, as the families are under no real obligation to see that consensual decision making is taking place: they do not have oversight by the federal government, and they suffer no real consequence if they do make decisions for their elders without consulting the elders in question But if service providers are taking away client choice and making important day to day decisions for clients they are breaching their agreement with the federal government.
I work in aged care service provision. We abide by the Aged Care Quality Standards, which are couched in terms of self-determination and the clients right to choose the services they wish. Also, the approved set of “Aged Care Rights:” are both provided to and explained to each client as they enter service, so they are clear on the fact that they have choice and the ability to change or quit services as they feel they need to. In other words, all the things which OPAN (bless them) are talking about and fighting for.
The Home Care and NDIS Packages were an attempt by the federal government to put decision making squarely into the hands of clients receiving care services. The fact that some agencies are essentially non-compliant (although they are no doubt “compliant on paper”) means they are in breach of what is now common practice amongst aged care service providers, and they will likely always be so as they are more concerned with ticking boxes to ensure future funding than implementing the changes which have been in effect for a number of years across aged care agencies for the betterment of the clients they serve. Chasing the dollar is obviously far more important to these organisations than the provision of quality care. Shame, shame, shame on them.