BLOG: Improving the quality and safety of advance care plans 

Our National Advance Care Planning Documentation Prevalence Study found that 30% of people in residential aged care had advance care planning documents (with life limiting instructions) completed by someone else.  

Having an advance care directive (ACD) completed by the person is considered the gold standard in advance care planning and is what the law requires. However, there are circumstances where advance care directives are not possible and advance care plans written by someone else (not legally binding) may provide an understanding of the person’s future preferences.  
Unlike advance care directives, there is no legal framework for these documents. In the interests of quality and safety, we have released an advance care plan form for a person with insufficient decision-making capacity (e.g. moderate to severe dementia).

This document is most relevant to aged care service, and especially residential aged providers as many people living in residential aged care have cognitive impairment and may have lost decision-making capacity.  

This form can be used nationally but when an advance care plan form exists in a particular jurisdiction, we recommend using theirs.  

The new advance care plan form includes guidance on completing the form. It guides the person’s substitute decision-maker how to document their understanding of the person’s future care preferences.  

Although not a legally binding document, advance care plans are useful for guiding medical decision making for substitute decision-makers and clinicians. The form makes this clear to both the person writing it and the clinician interpreting it.  

Need help? 

We offer free support for both health and aged care workers and the public. Call 1300 208 582, Mon-Fri, 9am-5pm AEST.