Inpatient guardians: learning about guardianship, rights and decision making
Presentation transcript
Welcome to this session on inpatient guardianship, designed specifically for student social workers.
We'll cover the role of the Office of the Public Guardian, the legal framework, what decision making ability means and how guardianship fits into patient care.
By the end, you'll have a clear understanding of when and how guardians are involved and your role in supporting patients and families.
We begin by Acknowledging the Traditional Custodians of the lands across Queensland, paying respect to Elders past, present and emerging.
The Office of the Public Guardian, or OPG, is an independent statutory office.
For adults, we act as guardian of last resort for those with impaired decision making ability.
We also have important functions in child advocacy.
In this session we'll focus on the adult guardianship role, especially in hospital settings.
Guardianship in Queensland is guided by multiple laws.
The Guardianship and Administration Act and Powers of Attorney Act define decision making ability and substitute decision makers.
The Public Guardian Act establishes OPG.
Other laws like the Disability Services Act and the Mental Health Act can also apply.
The Human Rights Act requires us to protect rights and minimise restrictions.
Internationally, conventions like the UN convention on the Rights of Persons with Disabilities also guide our work.
Decision making ability is a legal concept.
The law presumes that adults have capacity to make their own decisions unless shown otherwise.
It is a fundamental human right.
To have ability, a person must be able to understand the decision, weigh up the pros and cons, make a free choice, and communicate it in some way.
As social workers, you may be asked to consider whether someone has decision making ability.
This is always linked to the particular decision.
Someone may be able to decide what to eat, but not about complex medical treatment.
Ability can vary across domains like health or accommodation, and it can fluctuate over time.
Many factors influence decision making ability.
It could be the type of impairment, how complex the decision is, or whether the person has enough support and information.
Stress, health and environment also play a part.
This is why assessments must be careful and individualised.
The law and good practice require us to support people to make their own decisions wherever possible.
That might mean using plain language, visual aids or giving extra time.
It also means encouraging family or networks to provide support.
Only when the supports are not enough do we turn to substituted decision making.
If supported decision making is not enough for a person to be guided to make their own health care decisions, there are other options.
In the first instance, an Advance Health Directive needs to be followed.
An Advance Health Directive is a set of instructions about your future health care developed by the person while they had ability.
If that is not enough or the person does not have an Advance Health Directive, health care decisions for the person are referred to their nominated attorney as listed in their Enduring Power of Attorney.
If they don't have an Enduring Power of Attorney, then you can refer to a statutory health attorney, which may be the person's spouse, unpaid carer, close friend or family member.
If no substitute decision maker can be identified, then a guardian can be appointed by the Queensland Civil and Administrative Tribunal as a last resort.
It is important to note that their appointment is limited to decisions within the area of appointment on the order.
The role of OPG impatient guardians.
Acting as guardian for clients when they are admitted to hospital.
Inpatient guardians provide decision making services to OPG clients in hospital under a collaboration agreement.
This may involve helping with discharge planning, deciding on accommodation or services, and providing guidance and support around decision making.
The role is always about balancing rights and wishes with clinical needs and safety.
Before being appointed as guardian, we can attend QCAT hospital hearings where the application proposes the Public Guardian to be appointed as guardian.
Prior to the hearing, we can speak with the adult and comfort them since the process can be rather overwhelming, confusing and scary.
We also provide educational sessions to hospital staff and students and client family so they can better understand OPG and the role of the inpatient guardian.
We attend family meetings even if OPG is not appointed as guardian.
This could be to discuss the role of a guardian when family are going to act as a person's guardian.
Some families can find the role of a guardian to be overwhelming, so these sessions can be helpful to them.
We are a point of contact for health staff who need information.
For example, confirmation if OPG has been appointed and if so, for what areas.
This is a common question.
We share that OPG has other functions, including investigations, our legal team and community visitors.
It is useful to know in case there are concerns about abuse or if the family discharges the adult against medical advice.
It is important to understand the boundaries of guardianship.
Guardians can make decisions about health, accommodation and services and they will consult with the treating team.
They may consult with the family if needed.
If they understand what the views, wishes and preferences of the client would be.
Inpatient Guardians may make decisions in relation to personal matters depending on the areas of appointment.
This may include decisions about health care, accommodation and services.
They don't manage daily ward issues, replace clinicians or make decisions outside what the Queensland Civil and Administrative Tribunal has ordered.
The Public Guardian only becomes involved through a Queensland Civil and Administrative Tribunal appointment.
The Queensland Civil and Administrative Tribunal holds a hearing, considers evidence about decision making ability and need, and decides whether to appoint a guardian.
Appointments are limited in scope and are always subject to review.
What if there is no inpatient guardian at your hospital?
If there is no inpatient guardian available at your hospital and the patient doesn't have an allocated guardian, you may call the OPG general line on 1300 653 187.
It is open from 9 a.m. to 4 p.m. Monday to Friday, excluding public holidays.
Please note, if family members are available but OPG has been approached, then you need to be prepared to provide detailed information and confirm why.
To wrap up, always presume ability and provide support.
Know the hierarchy of substitute decision makers.
Remember, OPG is a guardian of last resort appointed by the Queensland Civil and Administrative Tribunal.
And as social workers, your communication and documentation makes a real difference.
Importantly, also remember that once a patient has a guardian, you cannot seek consent from the patient, only from the guardian.
For more information or if you need to raise a matter urgently, please contact the Office of the Public Guardian.
We can be reached by phone, email or through our website.
Complaints can also be made directly to our complaints team.
Thank you.