Older Australians shunning advance care directive

Older Australians are shunning the opportunity to complete an advance care directive.

care plan

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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    28th Jun 2019
    I can't understand anyone not having a statutory will, powers of guardianship and attorney and an advance care directive. After all , you don't have to go to a solicitor to make these legal documents - do the research, get the appropriate form if any and clearly state your wishes. Sign in front of a JP or another authorised person and include a second witness signature if required. Simple and almost no cost. I wish that my mother had the foresight to prepare powers of attorney and guardianship before she got advanced dementia - it would have simplified my life enormously and saved thousands of dollars in ongoing costs to maintain her estate and arrange for her care.
    28th Jun 2019
    Once you can no longer communicate or are labelled as “Mentally Incompetent”, if someone disagrees with your stated wishes, they can go to VCAT and VCAT can overturn the directives and Powers of Attorney and appoint somebody else against your wishes.
    28th Jun 2019
    Jeez - that would take down many of our politicians and the like..... VCAT would have a field day ....
    28th Jun 2019
    A lot of people do not have children or relatives who are willing to deal with an Advance Care directive or an Enduring Power of Attorney. My children are amongst those not willing and as I have no other relatives in Australia I have no-one to give the documents to.
    28th Jun 2019
    Unikat, VCAT will only overturn a legally binding document if those wishing this can prove that the person who made the document was mentally incompetent at the the time of doing so. Adding a statement at the time re your mental competence will go a long way to preventing this occurring. To AutumnOz, makes you wonder why we bother to have children - one of mine is the same, but fortunately the other 2 are willing to step up if it becomes necessary. Hospitals and nursing homes now want if possible an advance care directive prior to admission and will consider your wishes when organising care and treatment.

    28th Jun 2019
    What a variety of rules for different States. Why can't they have the same rules / documents?

    28th Jun 2019
    I merely say:- "If I ever get that bad - shoot me!" or, "They'll find me tied to the wheel of the yacht!" - except I sold it for a song after the marina owner rammed and sank it and didn't own up to it. Hope she's on the seven seas again...
    28th Jun 2019
    If you do not have a GP you cannot do this directive. Poor people go to 24 hour clinics and have a GP - whoever is available. This document must be signed by your GP. i wrote my own and gave to my next-of-kin - the next best idea.
    28th Jun 2019
    If one chooses an assisted death but doesn't live in Victoria, their wishes can't be carried out. Let's hope that other states come on board to give people this very important choice.

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