Aged care considerations

Why advance care planning is important for older people

It’s more common for people to lose the ability to make or communicate decisions as they get older, and near the end of their life. Advance care planning can empower the older person to share their values and preferences about health care. It also supports an enduring voice should they lose decision-making capacity.

The principles underpinning advance care planning align to the rights-based approach outlined in the Statement of Rights in the new Aged Care Act. Learn more about the Aged Care Act on the Australian Government website.

Advance care planning is a voluntary process and, at all times, the older person decides if, and how they participate in the process. Older people have choice and control over their future health decisions.

End of Life Directions for Aged Care (ELDAC), End of Life Law for Clinicians and Advance Care Planning Australia have created a video to assist healthcare professionals and aged care providers answer seven common questions about Advance Care Directives.

Watch the video here.

Your role as an aged care staff member

Many people admitted to residential aged care have cognitive impairment and may have impaired decision-making capacity. This limits their ability to undertake advance care planning. The Aged Care Act and the Strengthened Quality Standards require that a supported decision-making approach is used wherever possible, if a person still has some decision-making capacity. Community aged care providers are in a better position than hospitals or residential aged care providers to start advance care planning with clients. This is because community aged care clients are less likely to have cognitive impairment and are more likely to be in a stable condition.

Residential aged care providers can still play a key role in advance care planning by:

• identifying if a resident has an advance care directive
• identifying the resident’s substitute decision-maker
• talking with residents about their values and preferences, regardless of cognitive capacity, and involving their substitute decision-maker and others, such as family, in the conversations
• ensuring timely sharing of information with other services and healthcare providers if the older person doesn’t have capacity and a treatment decision or transfer of care is needed.

All aged care staff have a role in supporting an older person with the advance care planning process . AHPRA registered health professionals have legal obligations to review and consider a person’s advance care directive. They must always act within their scope of practice.

A high proportion of care for older people in the community and residential aged care is delivered by care workers who aren’t registered health professionals. The role of care workers isn’t clearly defined in legislation governing advance care planning. Organisations should get advice from their own legal advisers and insurers. This will help them ensure that their advance care planning policies and procedures appropriately recognise the scope of practice of different groups of staff. In particular, their policies and procedures for medical emergencies should consider:

• respect for a person’s instructions in a valid advance care directive
• accurate interpretation of advance care planning documents
• the person’s rights as the central concern.

Find out more about the role all health and aged care staff have in advance care planning.

Understanding dementia

People with dementia face significant challenges in planning for future care. As dementia progresses, a person’s capacity to make and communicate decisions about everyday life, health and end of life care will reduce. Complex health and personal decisions often need to involve family or carers who may be unsure about the person’s preferences.

It’s important for someone with dementia to start planning as early as possible. This way, they can take part in decisions about their health before any cognitive decline.

Without advance care planning, someone with dementia may be given treatments they wouldn’t want, such as hospitalisation, intravenous therapy, and tube feeding. Advance care planning may improve the quality of care for people with dementia. It’s linked to lower rates of hospitalisation and higher use of hospice services among people with dementia. It can also reduce stress, anxiety and depression for loved ones.

The Advance Project offers free, practical, evidence-based dementia training and resources on their website. They help aged care professionals start end of life conversations with people living with dementia.

Dementia Australia has information to help people living with dementia plan ahead for when they may no longer be able to make decisions on their own.

Learn more in our position statement on dementia.

Supporting service delivery

ACPA Learning

To learn more about advance care planning try our microlearning campaigns.

ELDAC (End of Life Directions for Aged Care)

ELDAC (End of Life Directions for Aged Care) provides information, guidance, and resources for all aged care staff to support palliative care and advance care planning. Visit their End of Life Law Toolkit website which provides practical information at the end of life for the aged care sector. It has useful resources on end of life legal issues commonly encountered in aged care. It also has factsheets for each state and territory that explain key laws about medical treatment decision-making at the end of life with older people receiving aged care.

End of Life Law for Clinicians

End of Life Law for Clinicians (ELLC) is a free training program about the law on end of life decision-making. The ELLC aged care course is for nurses, GPs, other medical practitioners, allied and other health professionals, and mangers working in residential care, and home and community care. To enrol, visit the ELLC learning platform and select aged care.

Advance Care Planning: Aged Care Implementation Guide

The Advance Care Planning: Aged Care Implementation Guide can help you support older people with advance care planning. It includes information for aged care providers about engaging with patients and families, policies and procedures, and the law in each state and territory.

Download the Advance care planning in aged care guide [PDF 838.13 KB]

Please note this resource is under review.

Strengthened Quality Standards

Advance care planning is explicitly embedded within the Strengthened Quality Standards:

• Standard 3: Care and services – Outcome 3.1 Assessment and planning
• Standard 5: Clinical care - Outcome 5.7 Palliative care and end of life care

Draft guidance material helps workers and providers understand their responsibilities and how to conform to the strengthened Quality Standards. Read the guidance material on the Australian Government Aged Care Quality and Safety Commission website. It’s in draft form until the Aged Care Act comes into effect in November 2025.