Guide to adopt supported decision-making

Dr Sinclair

A step-by-step policy guide for aged care providers to help deliver the best quality care was launched by CDPC chief investigator Dr Craig Sinclair in Sydney on June 5.

More than 85 people, many from the aged care sector, attended the launch of the policy guidelines document that will assist Australian aged care providers adopt the contemporary best practice principles of supported decision-making.

The document, “Supported Decision-Making in Aged Care: A Policy Development Guideline for Aged Care Providers in Australia” was an outcome of a larger project on supported decision-making among people living with dementia, also funded through the CDPC. The project interviewed people with dementia and their family members as well as professionals involved in dementia care, reviewed legislation relating to decision making and current policies of aged care providers.

Emeritus Professor Terry Carney from the University of Sydney Law School and a specialist in adult guardianship, health and child welfare law in his welcoming address applauded the usefulness of the guidelines for aged care providers to implement supported decision making.

“Supported decision-making turns on its head or reverses the way the law has thought about people who have cognitive decline, whether it be an intellectual disability, acquired brain injury or mental illness or dementia.

“The law has viewed this as on or off, you either have capacity or you don’t have capacity. And it has largely been left to the medical profession to apply an often narrow clinical measure.

“In the 80s in Australia the guardianship laws were modernised so it became a more functional assessment but it was still the taking away completely the decision making power from the person affected and the transfer of that responsibility to a guardian,” Emeritus Professor Carney said.

He stressed the importance of people planning ahead, for example, after an initial dementia diagnosis, and execute advanced planning and powers of attorney and appoint someone you have chosen rather than the tribunal.

“Supported decision-making is now an internationally mandated principle of international law under the Convention on the Rights of People with Disability goes to the opposite end to that spectrum and says we must totally abolish substitute decision making.

“It is difficult to implement but we must make every single endeavour to keep any substitute decision making process as an absolute last resort.

Dr Sinclair said the research used the Australian Law Reform Commission’s (ALRC) National Decision-Making Principles as the guiding framework.

“Supported decision-making is a practice that enables people to make decisions about their own life. Enabling the person to be involved in decisions that affect their care is a key focus of the ALRC National Decision-Making Principles.

“In the guidelines we have tried to illustrate how the principles from the Australian Law Reform Commission map across to the incoming single quality framework for accreditation of aged care providers.

“An Action Plan for policy development for aged care organisations, outlined in the document, provides a range of practical tools including a self-assessment tool to assess their current policies, an interactive case study and a Model Policy Framework to assist in reframing their current policy setting,” Dr Sinclair said.

Links
Supported Decision Making resources webpage

Notes
As a signatory to the United Nations Convention on the Rights of Persons with Disabilities, Australia has an obligation to address matters relating to consent and supported decision-making. In response the ALRC released a report in 2014, which outlined four key principles, see https://www.alrc.gov.au/publications/equality-capacity-disability-report-124

Launch audience