ACPA COVID-19 Healthcare Planning

ACPA COVID-19 healthcare planning

Advance care planning is an important part of Australia’s COVID-19 healthcare planning. The Australian Health Management Plan for Pandemic Influenza 2019 cites the importance of Advance Care Directives as part of a coordinated response. However, current research demonstrates that only 25% of older Australians aged 65+ years have documented their preferences in an Advance Care Directive. Despite this, individuals often report benefits in doing advance care planning. 

Advance Care Planning Australia (ACPA) provides the following advice to healthcare providers and sectors across Australia. This information is likely to be updated regularly so please return to this page for the latest information. 

Further national advance care planning advice is available via the National Advisory Services 1300 208 582, 9am – 5pm, Monday – Friday (AEST) and/or ACPA Learning hub. 

Advance Care Planning Australia is urging aged care providers to include advance care planning in their management of COVID-19.

Aged care providers have obligations under the Aged Care Quality Standards. Standard 2. Requirement (2)(b) specifies that assessment and planning identifies and addresses the consumer’s current needs, goals and preferences, including advance care planning and end of life planning if the consumer wishes.

ACPA recommends aged care providers encourage aged care recipients with decision making capacity to: 

  • think about and discuss their future health care preferences with loved ones and their treating medical practitioner
  • identify their substitute decision-maker(s). Appoint these when relevant and make this known to their treating medical practitioner or service
  • make existing Advance Care Directive documents available and store in their health record
  • document their preferences and acceptable / unacceptable outcomes (e.g. CPR, ventilation, loss of independence) in an Advance Care Directive.*

In addition, ACPA recommends the aged care workforce and providers: 

  • identify and assist high-risk patients who may want less treatment, to document these preferences in an Advance Care Directive*, service care plan and/or medical order
  • if conducting a COVID-19 telehealth advance care planning consultation, documents can be completed and signed with the use of email or fax
  • enter the individual’s substitute decision-maker details and/or Advance Care Directive into the health record for transfer between care providers. 

*COVID-19 restrictions create difficulties in getting Advance Care Directives signed by the appropriate people. Advance Care Directives can be completed with the use of email or fax. Alternatively, all states and territories (excluding Queensland) recognise common law Advance Care Directives. A common law Advance Care Directive can be created by using a recommended form or creating a letter, and should include the person’s:

  • name
  • date of birth
  • preferences for care
  • acceptable or unacceptable outcomes (e.g. CPR, ventilation, loss of independence)
  • substitute decision-maker
  • signature and date.

These preparations will support service providers in being able to offer appropriate, quality care to consumers.

Advance Care Planning Australia is urging healthcare practitioners and health service providers to include advance care planning in their management of COVID-19.

Health service providers have obligations under the National Quality and Safety Standards (Standards 2 and 5) to implement advance care planning.

ACPA recommends health practitioners and health service providers encourage consumers with decision making capacity to: 

  • think about and discuss their future health care preferences with loved ones and their treating medical practitioner
  • identify their substitute decision-maker(s). Appoint these when relevant and make this known to their treating medical practitioner or service
  • make existing Advance Care Directive documents available and store in their health record
  • document their preferences and acceptable / unacceptable outcomes (e.g. CPR, ventilation, loss of independence) in an Advance Care Directive.*

In addition, ACPA recommends the health service workforce and providers: 

  • identify and assist high-risk patients who may want less treatment, to document these preferences in an Advance Care Directive*, Goals of Care form and/or medical order
  • if conducting a COVID-19 telehealth advance care planning consultation, documents can be completed and signed with the use of email or fax
  • enter the individual’s substitute decision-maker details and/or Advance Care Directive into the health record and provide a copy for transfer between care providers. 

*COVID-19 restrictions create difficulties in getting Advance Care Directives signed by the appropriate people. Advance Care Directives can be completed with the use of email or fax. Alternatively, all states and territories (excluding Queensland) recognise common law Advance Care Directives. A common law Advance Care Directive can be created by using a recommended form or creating a letter, and should include the person’s:

  • name
  • date of birth
  • preferences for care
  • acceptable or unacceptable outcomes (e.g. CPR, ventilation, loss of independence)
  • substitute decision-maker
  • signature and date.

These preparations will support service providers in being able to offer appropriate, quality care to consumers.

Advance Care Planning Australia is urging general practitioners to include advance care planning in their management of COVID-19.

General practitioners usually have ongoing and trusted relationships with their patients and are well positioned to initiate and promote advance care planning. General practitioners may want to support their patients to do advance care planning during COVID-19. A RACGP Advance Care Planning Position Statement is available.

ACPA recommends GPs encourage consumers with decision making capacity to: 

  • think about and discuss their future health care preferences with loved ones and their treating medical practitioner
  • identify their substitute decision-maker(s). Appoint these when relevant and make this known to their treating medical practitioner or service
  • make existing Advance Care Directive documents available and store in their health record
  • document their preferences and acceptable / unacceptable outcomes (e.g. CPR, ventilation, loss of independence) in an Advance Care Directive.*

In addition, ACPA recommends GPs: 

  • identify and assist high-risk patients who may want less treatment, to document these preferences in an Advance Care Directive*, clinical care plan and/or medical order
  • if conducting a COVID-19 telehealth advance care planning consultation, documents can be completed and signed with the use of email or fax
  • enter the individual’s substitute decision-maker details and/or Advance Care Directive into the health record and provide a copy for transfer between care providers. 

*COVID-19 restrictions create difficulties in getting Advance Care Directives signed by the appropriate people. Advance Care Directives can be completed with the use of email or fax. Alternatively, all states and territories (excluding Queensland) recognise common law Advance Care Directives. A common law Advance Care Directive can be created by using a recommended form or creating a letter, and should include the person’s:

  • name
  • date of birth
  • preferences for care
  • acceptable or unacceptable outcomes (e.g. CPR, ventilation, loss of independence)
  • substitute decision-maker
  • signature and date.
These preparations will support service providers in being able to offer appropriate, quality care to consumers.

For more information, resources and conversation starters see COVID-19:resources for general practitioners

Webinars

COVID-19 Webinars

  • Video

    COVID-19 and ACP for General Practitioners

    ACPA

    This webinar discusses the key ACP priorities and actions for GPs during COVID-19. It covers ethical considerations, ACP in CALD communities, the challenges of signing documents and more.
  • Video

    COVID-19 and ACP for Aged Care

    ACPA

    Hear from industry experts discuss key ACP priorities and actions for the Aged Care sector during COVID-19. This webinar covers the current challenges, ethical considerations and more.
  • Video

    COVID-19 and ACP for Healthcare

    ACPA

    This webinar covers key ACP information and considerations for health professionals during COVID-19. Hear from sector experts including intensive care leaders , A/Prof Charlie Corke and Dr Peter Saul and more.

COVID-19 Conversation starters

There are many ways to start the conversation. Here are a few suggestions:

  • You mentioned you were concerned about what would happen if you got the virus. Would you like to talk about this some more?
  • How are you going with your isolation? What do you think would happen if you got COVID-19?
  • Because of your severe lung (heart/kidney/cancer etc) disease you are more likely to get really sick if you got the virus. Have you thought about this?
  • I like to talk to my patients about what medical treatment they would want if they became unwell with COVID-19. It's such a challenging situation. Have you thought about this?
  • Can we talk about your future health care and any preferences you have?
  • COVID-19 can cause people to become suddenly and seriously unwell, requiring intensive treatment in hospital. This is often for a long period and unfortunately, many won't recover. Many older people prefer to limit certain treatments such as CPR or being placed on a ventilator. What are your thoughts about this?
  • You just told me that if you got COVID-19 you would not want to go to hospital. Can we talk about what that may mean and how we can support you to stay at home? What does it mean to you to live well?  What are your values, beliefs or preferences about medical treatment?
  • Have you thoughts about what medical treatment or health outcomes are acceptable or unacceptable to you?
  • Would you want to be transferred to hospital if you became unwell or would you prefer to stay here?
  • Have you spoken with your family about your choices?
  • Who would you trust to make your medical treatment decisions if you were unable to talk due to illness? What would you like them to say?
  • Do your loved ones know your wishes and preferences? I encourage you to discuss these with them.
  • It is really helpful for you and your family to discuss what you would want to happen if you got really sick.
  • would you be willing to document your preferences and values in an Advance Care Directive? This can help others to know what you want if you can't say so in future.
Fact sheets

Fact sheets and guides for health and care workers

  • Fact sheet

    Advance care planning fact sheet for care workers

    Advance Care Planning Australia

    Information about advance care planning for care workers.
  • Fact sheet

    Advance care planning fact sheet for healthcare professionals

    Advance Care Planning Australia

    Information about advance care planning for healthcare professionals.
  • Articles & Publications

    Advance care planning in aged care: A guide to support implementation in community and residential settings

    Advance Care Planning Australia

    This guide provides information to assist aged care providers, particularly managers and senior staff, in implementing advance care planning.
  • Fact sheet

    Advance Care Planning Guide for General Practice fact sheet

    Advance Care Planning Australia

    A guide to triggers and conversation starters for advance care planning discussions in general practice.
  • Fact sheet

    Frequently Asked Questions for General Practice on Advance Care Planning

    Advance Care Planning Australia

    A fact sheet with a list of questions and answers for general practitioners on advance care planning.
  • Fact sheet

    Advance Care Planning in General Practice: Guidance on use of MBS Items

    Advance Care Planning Australia

    This guide describes how MBS Item numbers may be used by GPs for Advance Care Planning (ACP) where clinically appropriate.
Learning materials

Webinars for health professionals

  • Video

    What is advance care planning?

    Decision Assist

    Learn about the principles of advance care planning int he first webinar of this series.
  • Video

    Advance care planning – how to

    Decision Assist

    Learn to recognise an opportunity to talk about advance care planning and how to have the conversation in this webinar.
  • Video

    Advance Care Planning in Primary Care

    Decision Assist

    A webinar designed to enhance the knowledge, skills and confidence of the primary care workforce to promote, initiate and continue discussions regarding future health preferences in routine care.
  • Video

    Grief, trauma and loss

    Decision Assist

    Understand the impact of changing health on people and their families, assist people with loss and provide referral to support services in this webinar.
  • Video

    We’re all different

    Decision Assist

    Recognise that people have varying beliefs and values, use conversational tools to discover the ways people differ, and find information about different cultural perspectives in this webinar.
  • Video

    George wants resuscitation

    Decision Assist

    Appreciate that people have choices in the care they want, be able to assist in making choices and be comfortable with people’s decisions in this webinar.
  • Video

    Jane does not want to go to hospital

    Decision Assist

    Recognise that people may not all want the same level of care, know where to refer people for assistance and understand your role and responsibility in assisting people with their choices in this webinar.
  • Video

    Marjorie is breathless

    Decision Assist

    Learn about ways to make people more comfortable, understand patient choices and recognise other team members’ roles in this webinar.
  • Video

    Do you think dad is dying?

    Decision Assist

    Learn to recognise when end-of-life care is needed, and be able to assist and provide direction to support services in this webinar.