Aged care providers can help increase the uptake and implementation of advance care planning, according to a background paper released by the Royal Commission into Aged Care Quality and Safety.
The paper released this month shows that the majority of Australians are missing the opportunity to have a say in how they want to be cared for should they become incapacitated by dementia or other circumstances.
Only three out of every 100 older Australians have a statutory advance care directive, a review of existing research shows.
An advance care plan enables individuals to say how they want to be cared for, and what actions they want taken on their behalf in the event that they can no longer make decisions for themselves.
This can take the form of a conversation with health professionals, family or friends, or a formal directive in the form of a written document. All states and territories have specific advance directive forms.
“The objective of advance care planning is to guide future decision-making about a person’s treatment and care so that it is consistent with their goals, preferences and values,” the paper says.
Having an advance care plan in place can ease depression in people with dementia and those approaching end of life, the paper says. It can also take the burden off loved ones and family.
“Advance care planning has been shown to reduce unnecessary transfers from a residential aged care facility to a hospital and decrease a person’s level of worry and 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.”
However despite this, the limited research available suggests that advance care planning is uncommon in Australia, the report says.
A 2017 study found less than half (48 per cent) of people in residential care had an advance directive on file. The rate was 16 per cent in hospitals three per cent in general practice.
Less than 3 per cent had a statutory directive and only 11 per cent had a statutory directed appointing a decision maker.
The Royal Commission says the low rates could be the result of lack of awareness and understanding, as well a general reluctance to have end-of-life conversations.
It says this can be improved by better educating health care professionals and aged care staff and ensuring correct storage and filing of documents.
In the case of dementia, advance care planning should take place early and should cover not just medical decisions but also broader issues including financial, lifestyle and health and wellbeing matters.
The report is the latest in a series of background papers prepared by the Royal Commission. Previous paper have focused on restrictive practices, the nature and prevalence of dementia and pressures on the aged care system.
They can be accessed here.