An examination of organisational policies for healthcare and lifestyle decision‐making among Australian aged care providers

Abstract

Objective Examine policies of aged care organisations relating to healthcare and lifestyle decision‐making. Methods Seven aged care organisations submitted policy documents. Policies were analysed using the Australian Law Reform Commission (ALRC) “Decision‐Making Principles” as a framework. Senior staff (N = 9) with policy development roles participated in follow‐up interviews. Results The structure and content of policy documents varied significantly between organisations. Most acknowledged the need to support the rights of care recipients in decision‐making; however, the nature of this support was often unclear. Interview themes included factors relating to “organisational contexts” “policy development and implementation” and “ethical challenges.” An overarching theme among high‐performing organisations was “proactive response aimed at pre‐empting decision‐making dilemmas”. We provide recommendations for policy development, including a self‐assessment audit tool. Conclusion Aged care provider organisations may need to review policies in the areas of healthcare and lifestyle decision‐making to meet current best practice principles.

Challenges faced by residential aged care staff in decision-making for residents with dementia

“…Few participants could recall in any detail policies that had been developed by their services in relation to decision-making and residents with dementia. Where this may indicate that staff are not familiar with agency policy, it may also, consistent with the findings of Sinclair et al (2019), suggest a failure by RACFs to develop appropriately elaborated policy.…”

“…Researchers from the Australian Cognitive Decline Partnership Centre have developed recommendations for supporting decision-making by aged care providers that are endorsed here. Key actions identified include development of high-level policy documents that outline organisations’ approaches to decision-making and a decision-making tool that helps staff establish residents’ will and preference so as to inform decision-making ‘within a broader rights paradigm’ (Sinclair et al., 2018, p. 11). Staff also require guidance with regard to supporting the sexual needs of residents.…”

“…The Australian National Framework for Action on Dementia 2015-2019(Australian Health Ministry Advisory Council, 2015 also identifies as an action priority that 'care and support services' support those with dementia to 'exercise choice and decisionmaking' (p. 13). The Aged Care standards (Department of Health, 2018) recently introduced by the Aged Care Quality Agency state that consumers should be 'supported to exercise choice and independence' with respect to the maintenance of relationships of choice (p. 6).…”

“…Recent research, however, has found that RACFs in Australia lack robust policy on supporting residents to make their own decisions and on supporting others to make decisions on their behalf (surrogate decision-making). Sinclair et al (2019) found that the policies and procedures of organisations lacked clarity around capacity assessment, staff responsibilities vis-a`-vis decision-making and actions that are required to support residents to make decisions.…”

Organising care, practice and participative research: Papers from the cognitive decline partnership centre

“…Sinclair, Field, Blake and Radoslovich examine the Australian Law Reform Commission's “Decision Making Principles” for Australian aged care providers. Their paper looks at the policies of Australian aged care providers against a set of decision‐making principles based on international human rights instruments.…”