Grace is 83 and is mostly in good physical and mental health. Recently however, she had a fall and broke her hip.
After consultation with Grace’s medical and allied health treatment team, the hospital’s social worker discussed with Grace the risks of her returning home. Grace made clear her preference to remain in her own home despite those risks and that she was fully expecting to be discharged from hospital when she was ready.
To meet ‘duty of care’ obligations, Grace’s discharge was delayed until further assessment of her needs and alternative care arrangements (e.g., home care and residential aged care) were adequately discussed with her.
Tom is 81, and physically fit, however his family have noticed over the last 6 months that he is asking them the same questions every time they meet, and forgetting conversations. Sometimes he seems confused when they visit. His family feels he would be safer living in an aged care facility than at home by himself.
The decision to move into an aged care facility
No one, who has full capacity to make decisions, can be forced to move into aged care if they don’t want to. The decision to enter an aged care facility, and to remain there, sits with the older person (i.e., scenario 1 – Grace is within her rights to make the decision as to where she resides, even if she has had advice to the contrary).
However, if the person has impaired decision-making capacity, (as is possible in scenario 2), a substitute decision maker can decide to place the older person in a care facility. People can appoint their own substitute decision maker in an Enduring Power of Attorney document (provided they have capacity at the time of the appointment).
When there is not a current and valid Enduring Power of Attorney, the process of accessing Aged Care facilities may be delayed. A substitute decision maker can be appointed by the Queensland Civil and Administrative Tribunal (QCAT), but this may be a lengthy and emotional process.
A capacity assessment of the older person by a specialist doctor will be undertaken prior to an appointment by QCAT. A hospital, family member, social worker or another person cannot make an older person go into an aged care facility unless this process has been followed, or he/she makes their own decision to go.
Do I need to be assessed before I move into Aged Care?
To move into an aged care facility, the person will be required to undertake a free assessment with the Aged Care Assessment Team (ACAT). An ACAT member will assess whether they will be able to receive government-subsidised aged care services, and help identify what types of care they need or whether they can to stay at home. They will also discuss what options are available locally. A doctor or hospital can make a referral to an ACAT, as can the person themselves.
Types of Aged Care Arrangements
There are two types of aged care arrangements for older people who are unable to care for themselves and who cannot (or do not want to) live with family or friends:
- residential aged care in a residential aged care home
- home care package, which allows people to remain in their own home whilst receiving in-home care.
The options available will very much depend on the services available in the area in which the elderly person lives, and the level and amount of care they require.
An Aged Care Assessment Team (ACAT) from the Department of Social Services gives free advice on the options available to an older person in the area they live. The ACAT can help work out a person’s needs and make a referral to the appropriate services.