Substitute or supported decision-making?

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Dr Craig Sinclair presented research findings on a study for a CDPC project on supported decision making at the 50th Australian Association of Gerontology in Perth on 8-10 November.

The emerging practice of ‘supported decision-making’ has been explored in the disability sector, says Dr Sinclair, however there is very little research on this topic in the context of dementia, with substitute decision-making often being the default.

“With the shifts towards consumer-directed aged care, reviews of State, Territory and Commonwealth guardianship legislation and growing attention on supported decision-making, it is timely for aged care providers to review their policies in this area.”

“In particular we were interested in how these policies apply for people with dementia, and how the existing policies might accommodate ‘supported decision-making’ for people with dementia who are Aged Care recipients,” Dr Sinclair said.

The research team is in the final stages of developing a tool to assist aged care providers strengthen their policies on client consent and supported decision-making.

A ‘Policy Guidelines Document’ and an ‘Action Plan’ will shortly be available for aged care providers that have a number of tools to make the process easier and compliant.

“Our documents will provide a description of the Australian Law Reform Commission’s proposed ‘National Decision-Making Principles’, with emphasis on issues relevant to aged care providers, a ‘self-audit’ tool for self-assessing current policies, an interactive case study for use in discussions with staff and a number of recommendations for policy review.”

“We invited Aged Care Providers to submit their policy documents for review and analysed these documents with reference to the ‘National Decision-Making Principles proposed by the Australian Law Reform Commission, in their recent report on ‘Equality, Capacity and Disability in Commonwealth Laws’,” Dr Sinclair said.

The study involved a detailed analysis of the policies and procedures from seven Australian Aged Care Provider organisations, relating to healthcare and lifestyle decision-making.

“We found that most organisations’ policies were unclear in their approach to issues such as consent, capacity assessment or decision-making and guidance for staff in terms of their responsibilities, or the actions they might take to support a resident and or a client’s ability to make decisions,” Dr Sinclair said.

Interested aged care providers can contact and register to receive a copy of the completed resource, which will also be publicly available and disseminated on our website.