The Meeting Place

One third of Advanced Care Directives invalid: study

Almost a third of Advance Care Directives (ACDs) audited in Australian residential aged care facilities were found to be invalid following a nation-wide study led by Advance Care Planning Australia.

The study revealed that 30 per cent of ACDs in residential aged care had been completed by someone else (usually family members) on behalf of a non-competent person. Unsettlingly, 68 per cent of those documents included instructions for withholding life-sustaining treatment such as tube feeding or intravenous antibiotics. 

With a rapidly ageing Australian population, there’s a growing community expectation that people will continue to make their own medical treatment choices well into their senior years. Consumer dignity and choice was identified as the foundation quality standard by the Aged Care Quality and Safety Commission in July this year, highlighting a person’s right to make informed choices about their own care. 

An Advance Care Directive is a legal document outlining a person’s preferences and instructions for their future health care. The document comes into effect when a person is no longer capable of making their own medical decisions, providing a sense of certainty, choice and control in the face of declining health. However ACDs are only legal when completed and signed by person with decision-making capacity. 

This oversight potentially leaves aged care residents at risk of being denied access to medical treatment that they would have wanted, or given treatment they would have preferred to avoid. The ambiguity also creates risk and confusion for aged care staff, families and health care providers. 

ACPA has released ten recommendations in a position statement to strengthen the rigour and validity of ACDs and support the aged care sector in delivering legally-compliant and ethically-sound advance care planning. 

“Advance care planning offers the best chance for us to live life on our terms, as we grow older. 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,” explained Linda Nolte, Program Director of ACPA.

“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 recognises that the aged care sector is under pressure and needs support to ensure ACP is well-coordinated, delivered respectfully and within legal frameworks. We’re here to help with a range of free resources including online training for staff, access to legal forms and resources, and our National Advisory Service (1300 208 582) which operates Monday to Friday,” commented Ms Nolte.


The other thing most people dont fill out is the section about emergencies and what care do you want then. Here's the thing you only die once, but you can have many emergencies.

Qelle surprise!

When ACP's were introduced to replace enduring powers of attorney for health decisions, they were designed to be easier and less costly to put in place, so the theory was that people were more likely to have an ACP as opposed to an EPO, which had to be prepared by a legal practitioner .

It now turns out that people just don't think it will ever happen to them, so the ACP's are no more utilised than the EPO's were. As it happens, EPO's are far superior and completely legally binding and unable to be altered, whereas ACP's can be altered by the next of kin or in some circumstances the health provider, so they are not binding.

So rather than fessing up that it was a grave error to have ACP's replace EPO's for health decisions, we are stuck with these bits of paper which are not legally enforcable, can be altered by next of kin which may oppose the wishes of the person and are ignored by the aged care industry. It was a mistake that needs to be fixed.

Close Family usually know what someone would have wanted.

VCAT can summarily override any Powers of Attorney and appoint people, against the stated objections of the person concerned, handing such powers to strangers with no real knowledge of the person who they make decisions on behalf of.

In an emergency it is hard to think of everything and convey your wishes unambiguously.

How hospitals handle these conflicts can impact on whether simeone lives or dies.