Death not a popular topic

A majority of Australians are missing out on the opportunity to have a say in how they want to be cared for if they become incapacitated due to dementia or other circumstances, according to a paper released by the Royal Commission into Aged Care Quality and Safety.

The background paper says that in a review of existing research, it found only three out of every 100 older Australians had a statutory advance care directive.

A YourLifeChoices Flash Poll, Testing Your Knowledge About Wills, found that nine per cent of the 843 respondents had an advance care directive. Seventeen per cent had a financial power of attorney, 26 per cent an enduring power of attorney, 13 per cent a medical power of attorney, eight per cent an enduring power of guardianship and six per cent an end-of-life anticipatory directive. However, almost one-quarter (22 per cent) had none of these.

An advance care plan allows individuals to state how they want to be cared for, and what actions they want taken on their behalf if they can no longer make decisions for themselves. The plan assists health professionals, family and friends.

A 2017 Australian study assessed how many people aged 65 years or over had at least one advance directive on file. It found 48 per cent of people in residential care had an advance care directive and 16 per cent of those in hospitals.

However, most were non-statutory documents. Fewer than three per cent had a statutory advance directive outlining preferences for care, and only 11 per cent had a statutory advance directive appointing a substitute decision-maker.

The study did find, however, that the rates were significantly higher than those recorded in previous years. A 2014 study found zero advance directives among 100 elderly patients in a tertiary referral hospital.

The aged care royal commission believes aged care providers can help to increase the uptake of advance care planning through better education for healthcare professionals and aged care staff and correct storage and filing of documents.  

An advance care plan could reduce unnecessary transfers from a residential aged care facility to a hospital and decrease a person’s anxiety about their future, the paper says. “Advance care planning can also have benefits for the person’s family, by improving the family’s understanding of the person’s wishes and reducing stress, anxiety and depression in the surviving family by helping them prepare for a death.”

The paper stresses that the framing of the conversation is important. “Discussing how a person wants to live, not how they want to die, can make the conversation easier. Instead of focusing narrowly on medical interventions, it may be better to have a broader conversation about a person’s values and what is important to them in life. An appropriate person to initiate and facilitate the conversation also seems to be important.”

Below is a summary of the formal mechanisms for advance care planning in different states and territories.

Estate planning lawyer Rod Cunich told YourLifeChoices: “Maintaining dignity is the driving force, also avoiding as much pain as possible. Children may have very different views about what their dying parent would want. Having an advance care directive makes it easier for the children who don’t have to second-guess what the parent would want. They also avoid ‘blame’ for making decisions that aren’t approved of by family members if they are implementing their parents’ express wishes.”

Do you have an advance care directive?  Are you confident that your wishes are clear?

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Related articles:
‘How much longer do I have?’
Preparing for death – your death
‘Slow death is killing me and Mum’

Written by Janelle Ward

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