Choice, independence and quality of life | Aged Care Quality and Safety Commission

Legislation
Guidance

Outcome statement

The provider must support individuals to exercise choice and make decisions about their funded aged care services and provide them with support to exercise choice and make decisions when they want or need it.

The provider must provide individuals with timely, accurate, tailored and sufficient information about their funded aged care services, in a way they understand.

The provider must support individuals to exercise dignity of risk to achieve their goals and maintain independence and quality of life.

Actions

1.3.1

The provider implements a system to ensure information given to individuals to enable them to make informed decisions about their funded aged care and services:

a) is current, accurate and timely

b) is plainly expressed and presented in a way the individual understands.

1.3.2

The provider implements a system to ensure that individuals give their informed consent where this is required for a treatment, procedure or other intervention.

1.3.3

The provider implements a system:

a) to ensure individuals who require support with decision-making are identified and provided access to the support necessary to make, communicate and participate in decisions that affect their lives

b) that involves supporters of individuals where possible, for individuals who require support with decision-making

c) that uses substitute decision-makers only after all options to support an individual to make decisions are exhausted.

1.3.4

The provider supports individuals to access advocates of their choosing.

1.3.5

The provider supports individuals to live the best life they can, including by understanding the individual’s goals and preferences and enabling positive risk-taking that promotes the individual’s autonomy and quality of life.

1.3.6

The provider records, monitors and responds to changes to the individual’s quality of life.

Why is this outcome important?

Outcome 1.3 explains providers’ obligations to support older people in exercising their choices, independence and quality of life. Outcome 1.3 is relevant to, and supports, all other standards. To meet Outcome 1.3, providers and workers need to understand each older person so they can deliver person-centred care.

Supporting older people’s right to make informed choices and decisions about their aged care services is key to Outcome 1.3. It also helps empower older people to maintain their independence and quality of life. Providers should provide information in ways that meet the older person’s needs. This can be through:

accessible formats
translation services
extra time to process information.

Providers need to understand and support each older person’s language and communication needs and preferences. For example, providers could roster workers who speak the same language as an older person, or develop tailored communication cards for older people who require non-verbal communication methods.

Effective communication supports dignity of risk and helps people to give their informed consent. Outcome 1.3 makes sure providers support older people to take part in activities that improve their independence and quality of life.

Dignity of risk acknowledges that older people have the right to make informed choices and decisions, including decisions involving some risks to achieve their personal goals and maintain their wellbeing. This can help providers create a person-centred environment that respects the older person’s needs, goals and preferences, independence and choices. This in turn improves the older person’s quality of life. It is, however, important that providers balance older people’s choices with the rights of others. This includes consideration to workers’ safety. Using supported decision-making helps older people make complex choices. It makes sure their voices are heard, even when a supported decision-maker or substitute decision-maker is involved. Outcome 1.3 supports older people to make informed decisions and use substitute decision-makers only after all options to support an older person to make decisions are exhausted.

Respecting informed consent helps make sure older people have accurate and relevant information about their care. Before any changes are made to an older person’s care, providers need to give older people information about the change. Providers also need to give people time to think about, consult and make a decision based on their needs and preferences. This makes sure older people can be involved in their aged care services and supports their dignity and right to personal choice. Outcome 1.3 shows that it’s important to support older people to use advocates and involve supporters and others they may want to involve, such as family and carers in making decisions, if they want to. Older people’s choices should always be considered. This encourages a balanced approach to risk, safety and independence.

You need to give focus to:

informed consent
supporting older people to make informed choices and decisions about their aged care services
identifying older people who need supported decision-making
using substitute decision-makers only after all options to support an older person to make decisions are exhausted
making sure older people have access to advocates.

All providers delivering aged care services in a residential, home or community setting need to support older people to exercise choice, including dignity of risk and positive risk-taking, and make informed decisions about their aged care services. This is so you can optimise their independence and quality of life and support them to achieve their goals. Processes for supporting choice, independence and quality of life may differ between providers delivering aged care services in a residential care home, or in a home or community setting. For example, in aged care services delivered in a home or community setting, providers will need to deliver services in line with the older person's assessed needs and individual support plan, with a focus on helping them remain independent and safe at home for as long as possible. In this context, dignity of risk would include supporting the older person to make informed decisions within their own home and community and balancing this right with strategies that support their safety, wellbeing, autonomy and personal goals. Providers delivering aged care services in a residential care home may take a similar approach but in a more structured environment, where there is more direct, continuous oversight of the older person’s aged care services and management of risk.

Key Tasks

Put in place a system to provide information to older people.

Integrate this system with your organisation’s:

information management system and clinical information system (Outcomes 2.7 and 5.1)
communication system (Outcome 3.3)
risk management system (Outcome 2.4).

Make sure the system for providing information to older people includes information about how you support them to make informed choices. This includes information about dignity of risk and positive risk-taking. Risks are considered ‘positive’ if they encourage an older person’s independence and improve their quality of life.

Make sure the information you give to older people is current and accurate. Make sure you share information in a timely way with older people and others involved in their care and services, including:

supporters of older people
family
carers
workers
registered health practitioners and allied health professionals.

You need to share information in a way that meets each older person’s language and communication needs and preferences (Outcome 1.1). This may include using:

simple, plain language and avoiding medical jargon
inclusive formats to give older people information if they have communication barriers, such as using large text or images
language services. For example, interpreters and translators for older people:
- from culturally and linguistically diverse (CALD) backgrounds
- from Aboriginal and/or Torres Strait Islander backgrounds
- who are deaf, hard of hearing or deafblind.

Make sure older people understand the information you give them. Give them time to think about the information if they need it. This will help older people, their supporters and others they may want to involve, such as family and carers, to make informed decisions about their aged care services.

Put in place a system to get informed consent from older people.

You need a system that clearly explains:

situations where you need to get informed consent. You need to get informed consent before an older person receives a clinical care treatment, procedure or other intervention. This includes changes to their aged care services. For example, when:
- there are changes to fees and charges they have agreed to in the past (Outcome 1.4)
- you need to collect use, store, or share older people’s information (Outcomes 2.7, 3.1, 3.3, 3.4 and 7.2)
- you’re considering clinical interventions such as restrictive practices or escalating an older person to medical or emergency services (Outcome 3.2).
how to find out if an older person needs help to make decisions. This system needs to explain how the older person can be supported if they need it. This includes access to advocates they want.
how you support older people to make informed choices and take positive risks
how you support older people with dignity of risk (Outcomes 3.2 and 5.4). This includes risks that may be harmful to them, such as smoking.
how you explain dignity of risk and how it’s understood by the older person, their supporters and others they may want to involve, such as family and carers.
where older people haven’t given you informed consent. You need to explain the steps workers should take to understand why and if the organisation can provide more support to help the older person make a decision. Depending on the conversation, document this in your information management system (Outcome 2.7).

The guidance for Outcomes 3.2 and 5.4 has more information on dignity of risk and decision-making.

The guidance for Outcomes 6.1 and 6.2 has more information on dignity of risk for eating and drinking. This includes eating and drinking with acknowledged risk (EDAR).

Make sure that your systems for planning and delivering aged care services include the right people. This means making sure that you think about all people who the older person wants to be involved in the decision-making process.

When doing assessment and planning, including comprehensive care planning (Outcome 5.4) and advance care planning (Outcome 3.1), use the systems for planning and delivering aged care services to:

find out if an older person needs support to make decisions. Document this information. Help the older person get the support they need to make, share and take part in decisions that affect their lives. If the older person wants an advocate to support them, help the older person find an advocate.
identify which supporters, family and carers the older person wants to be involved in making decisions. Make sure:
- all relevant people are involved in future decisions
- substitute decision-makers are only asked to make health, medical, residential and other personal (but not financial or legal) decisions for an older person if they lose their decision-making capacity
- you keep records.
find out the older person’s needs, goals and preferences, so they can take positive risks. This supports the older person’s independence and quality of life. Make sure that dignity of risk is clearly shared with and understood by older people and those making decisions.
monitor changes to the older person’s quality of life. Take steps to manage and resolve any issues. Document this information in the older person’s care and services plan and progress notes.

Older people in residential care homes need different processes for assessing, monitoring and supporting their quality of life to people receiving home care. For providers delivering aged care services in a residential care home, the guidance for Outcome 7.1 has more information on how you can support an older person’s independence and quality of life.

Systems for planning and delivering aged care services need to be clear on what an organisation defines as a decision. This will depend on the type of aged care services you deliver. This helps workers, older people, their supporters and others they want to involve, understand when to follow your process for making decisions. For example, when the organisation or workers need to have formal conversations with older people or their substitute decision-maker or both.

The guidance for Outcomes 3.1 and 5.4 has more information on assessment and planning.

Outcome service context

For providers delivering aged care services in a home or community setting, make sure your assessment and planning system for delivering aged care services supports each older person’s activities of daily living. The system needs to be tailored to each older person’s needs, goals and preferences. Make sure to record these supports in the older person’s care and services plan. The system should support older people to:

do activities they want to do, both inside and outside of their home. This may include hobbies such as gardening or taking part in community or cultural events. This may also include activities that would be a normal part of their life at home, such as doing the laundry, setting the table or walking. For example, you are required to provide mobility assistance to the older person, if they are assessed as needing personal care services to help manage their activities of daily living.
maintain physical independence and autonomy. For example, you can support older people by providing them with, and educating them about mobility aids and practises, such as a self-help 4-wheeled walker. Make sure to involve the older person in selecting strategies that promote physical independence and autonomy.
support older people’s choice and decisions to take risks. This includes helping older people make informed decisions and exercise dignity of risk. For example, you can support an older person to eat cultural dishes safely by modifying their texture. You should support workers to educate family members on how to use the strategies to safely assist older people’s choices.

The system should also include processes to:

monitor and respond to the older person’s change in care needs and emerging risks. This is done as a part of care management support, which is delivered by a provider delivering aged care services in a home or community setting through a care partner. This supports older people to achieve the best outcomes from the services they receive. If the older person’s change in circumstances escalates beyond the scope of care management, providers delivering aged care services in a home or community setting can request a Support Plan Review (by an aged care assessor) to determine if they are still having their needs met. If the support plan is not meeting the older person’s needs, the assessor may update the current plan or conduct a new assessment if their circumstances have changed significantly.
document any activities, strategies or supports for each older person in their care and services plan and routinely monitor and update the plan if needs, goals or preferences change.
obtain feedback from older people, carers and workers on changes to the older person’s wellbeing and quality of life without having direct oversight over their delivery of aged care services.
recognise and respect the rights and autonomy of older people. This includes their right to intimacy, sexual and gender expression. For example, you must support older people to spend time with whoever they want and respect their privacy.

Make sure workers have the time, support, resources and skills to help older people to make decisions about their aged care services.

Give workers guidance and training on how to support older people to make decisions about their aged care services (Outcome 2.9). This needs to be in line with:

the organisation’s policies and procedures
contemporary, evidence-based practice
workers’ roles and responsibilities.

Make sure workers understand how to:

use the organisation’s systems to share information with older people
get informed consent from the older person
involve the right people in making decisions
correctly document each of these steps.

The guidance for Outcomes 2.8 and 2.9 has more information on workforce planning and worker training.

Monitor how you deliver aged care services to make sure workers help older people to make decisions about their aged care services.

Make sure your workers are following your:

information management system (Outcome 2.7)
clinical information system (Outcome 5.1)
communication system (Outcome 3.3).

To check if workers are helping older people to understand their dignity of risk and make decisions, you can review:

older people’s aged care services (Outcome 3.1). For example, care and services plans and progress notes.
complaints and feedback (Outcome 2.6a and 2.6b)
information about incidents and near misses (Outcome 2.5).

Look for situations where workers haven’t:

supported the older person to make informed choices or decisions
supported the older person with dignity of risk
provided information in a way the older person can view or understand.

Also, talk with older people, their supporters and others they want to involve, about the aged care services they receive (Outcome 2.1). Ask them about how workers have supported them to make choices. Ask them if the information workers have given them has been in a way they can view and understand. These conversations can then inform continuous improvement actions and planning (Outcome 2.1).

Assess if workers are following your quality system (Outcome 2.9). You can do this through quality assurance and system reviews.

If you find issues or ways you can improve through your reviews and assessments, you need to address them. If things go wrong, you need to:

practise open disclosure. This means being open about what has gone wrong. Share what went wrong with older people, their supporters and others they may want to involve, such as family and carers.
put in place strategies to mitigate the risk of things going wrong again.

The guidance for Outcome 2.3 has more information on monitoring the quality system.

Further resources about this outcome can be found on the Commission's Quality Standards Resource Centre.

Outcome 1.3: Choice, independence and quality of life

Outcome 1.3: Choice, independence and quality of life

Outcome statement

Actions

Why is this outcome important?

Key Tasks

Update to guidance