Residential aged care decisions for clients of the Public Guardian
The Office of the Public Guardian (OPG) may consider a residential aged care placement for a person if all community-based options for their proper care and support have been exhausted, and if they would be placed at unacceptable risk of harm or neglect if they were to remain living in their current accommodation arrangements.
What are the General Principles?
As with all substituted decisions, the Public Guardian is required to apply the General Principles of the Guardianship and Administration Act 2000 when considering whether to make a residential aged care decision. These include:
- The person should be encouraged and supported to live a life in the general community, take part in activities enjoyed by the general community, and perform valued social roles.
- The person should be encouraged and supported to achieve their maximum physical, social, emotional and intellectual potential, and to become as self-reliant as possible.
- The person has a right to participate in decisions that affect their life, to the greatest extent practicable, and should be given the necessary support to do so.
- The person’s existing supportive relationships should be maintained.
- The adult’s cultural and linguistic environment, and set of values (including religious beliefs) must be taken into account.
What does a guardian take into account when deciding whether to make a residential aged care decision?
a) The scope of the Public Guardian’s appointment by the Queensland Civil and Administrative Tribunal (QCAT). A residential aged care placement can be considered if the QCAT order includes an appointment for accommodation matters.
b) The person’s views and wishes, and their ability to participate in the decision-making process.
c) Whether all reasonable attempts to source and trial in-home supports have been made.
d) The appropriateness of the proposed facility to meet the person’s:
- medical/support needs
- cultural/linguistic/religious needs
- ability to access and participate in community life and activities.
e) The views and wishes of the person’s family and friends.
f) The location of the facility and its proximity to family and community supports.
g) The accreditation status of the aged care facility.
h) Any specialist advice from doctors or other health professionals.
i) The person’s ability to pay (as advised by their financial administrator).
j) For people under 65 years of age, whether all options for them to remain living in age-appropriate settings in the community have been exhausted.
The OPG endeavours to make all decisions in a timely manner. However, a number of factors may impact on the decision-making process and the timeframe in which a decision can be made, for example in cases where:
- the person or their family is objecting to the nursing home placement
- there is conflict within the person’s family about the decision
- there are delays in the person’s financial administrator being able to confirm the person’s ability to pay for the proposed placement
- the person has complex behavioural or medical issues which require specialist support
- the person has specific cultural/religious needs
- it is highly desirable that the person be placed in a particular locale.
What information do guardians require in order to make a residential aged care decision?
A guardian has a right to all information necessary to make an informed decision (as per s.44 of the Guardianship and Administration Act 2000). For residential aged care decisions, the information required usually includes (but is not limited to):
- ACAT assessment
- medical history including any functional, OT or specialist assessments
- social history including any supportive relationships in the person’s life, the person’s accommodation history, and their views and wishes about their accommodation and care
- current or previous community supports received, either funded or unfunded
- details of any return-to-home trials undertaken and/or other accommodation options explored
- applications/approvals for home care package or other in-home supports
- eligibility for funded disability supports (for people under 65 years)
- confirmation from the person’s financial administrator about their ability to pay for the proposed placement.
If any of the above information can be provided to QCAT upon applying for the appointment of a guardian, or immediately upon the Public Guardian’s appointment, this will be of great assistance.