Inpatient guardians: supporting patient rights and clinical care
Presentation transcript
Welcome to this session on inpatient guardianship for allied health staff.
Today we'll cover who the Office of the Public Guardian is, what our role is, how decision making ability is assessed, and how allied health professionals play a key role in supporting patients throughout this process.
We begin by acknowledging the Traditional Custodians of the lands across Queensland. We pay our respects to Elders past, present and emerging.
The Office of the Public Guardian is an independent statutory office. We protect the rights and interests of vulnerable Queenslanders.
For adults, we may be appointed by the Queensland Civil and Administrative Tribunal as guardian of last resort, where there are no other appropriate substitute decision makers.
Guardianship decisions are shaped by several key laws. These include the Guardianship and Administration Act, the Powers of Attorney Act and the Public Guardian Act.
Other relevant laws include the Disability Services Act, the Mental Health Act and the Forensic Disability Act.
The Human Rights Act also requires us to ensure decisions are the least restrictive possible.
The law presumes that every adult has decision making ability.
Ability is defined as being able to understand the nature and effect of the decision, weigh up the consequences, make a free and voluntary choice, and communicate that choice.
As allied health workers, you will often see that ability is not all or nothing.
It is decision specific, domain specific, and time specific.
For example, a patient may be able to decide what to eat, but not able to plan a discharge.
Our obligation is to encourage supported decision making as much as possible.
This might mean simplifying information, using plain language or visual aids, and giving people more time.
The goal is to maximise autonomy before resorting 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 decision making ability.
If that is not enough, or the person does not have an Advance Health Directive, healthcare 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 there is no other statutory health attorney who is not culturally appropriate or no substitute decision maker is readily available, then the public guardian is a statutory health attorney of last resort.
If ongoing health care decisions are required, 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 the OPG inpatient guardians:
Acting as guardian for clients when they are admitted to hospital.
Inpatient guardians provide decision making services to OPG clients in hospitals 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 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's 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.
From an allied health perspective, red flags include patients unable to engage with significant decisions and no substitute decision maker is available.
A guardian may also be required if informal supports are unable to come to an agreement, and this is placing the adult at risk.
Allied health professionals play a critical role.
You are often the first to notice if a patient struggles with decision making.
Your documentation is vital.
Always check for substitute decision makers and communicate with the treating team, family and OPG where relevant.
When appointed, OPG guardians make decisions within their area of appointment, which may include health care, accommodation and services.
They will engage with the adult in the first instance, and may only engage with family when necessary.
They will always aim to reflect the person's will and preferences.
Appointments are subject to review by the Queensland Civil and Administrative Tribunal.
We are a safeguard, not a default option.
It is important to know what guardians do not do.
They don't manage everyday ward issues.
They don't replace the clinical decision making role of doctors or allied health, and they only make decisions in the areas for which the Queensland Civil and Administrative Tribunal has appointed them.
They also do not provide case management services, including sourcing accommodation options or organising aged care placements.
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 9am to 4 pm, 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 to confirm why.
To summarise, presume ability first and engage in supported decision making in the first instance.
If that is not possible, follow an Advance Health Directive.
If none exists, then you will need to engage a substitute decision maker.
If the adult has an Enduring Power of Attorney, the substitute decision maker is the attorney listed in that.
If they don't have an Enduring Power of Attorney, then you may seek a statutory health attorney.
An OPG Guardian can be appointed by the Queensland Civil and Administrative Tribunal, but this is the last resort.
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.