Residential aged care staff

Aged care facilities are ideally placed to identify the early signs of financial mismanagement and abuse. Our investigations team often receives referrals from residential aged care facilities when fees are in arrears because this is often a sign that the adult’s funds are not being used for their own care.

However issues are often not referred to us until the debt is significant. In one case, the fees were more than $50,000 in arrears.

That’s why we actively encourage residential aged care facilities to contact us early after just a few missed payments. If left too long the money may be irretrievable, which can lead to the adult losing all their funds and being evicted, and the facility may end up out of pocket.

Dealing with instructions from an attorney that may not be in an adult’s best interests

Something we see frequently is an adult’s attorney (acting under an Enduring Power of Attorney) telling a residential aged care facility that certain people can’t visit an adult.

This can cause family conflict and isolate an adult. We would like to highlight to facilities that they don’t need to automatically follow an attorney’s instruction and, in many cases, the attorney may be acting outside their role’s scope (especially if they aren’t acting in the adult’s best interests). Our Responsibilities of an Attorney Under an Enduring Power of Attorney factsheet provides more information about how an attorney should and shouldn’t act.

Isolating an adult from friends and family may make them more vulnerable to financial abuse from their attorney. Therefore, we encourage residential aged care facilities to put processes in place to mediate in this situation. This could be as simple as raising your concerns with the adult’s family. However, if approaching the facility’s management doesn’t help, you may need to approach an advocacy service or even apply to the Queensland Civil and Administrative Tribunal (QCAT) to have a power of attorney revoked.

When does an EPA come into effect?

It’s also important to understand when an Enduring Power of Attorney becomes effective. The adult can request that someone act as an attorney for financial matters from any point of time, even if they still have decision-making capacity. However, an attorney’s powers for personal and health care matters don’t become effective until the adult has lost capacity.

For example, if a resident still has capacity but has asked their adult son to manage their financial affairs through an Enduring Power of Attorney, their son cannot make any personal or health care decisions at this point, even if they have been nominated for personal and healthcare matters. This power will not take effect unless the resident loses capacity.

Asking residents to complete an Enduring Power of Attorney

We are aware that most aged care facilities request that new residents provide the facility with copies of their Enduring Power of Attorney, Advance Health Directive or Statement of Choices documents. This assists staff to know a resident’s wishes, preferences and who is legally empowered to make decisions if they’re incapable.

However, issues can arise when supplying completed documents is a condition of entry to aged care. Many elder abuse cases are perpetrated by a person appointed under an Enduring Power of Attorney. That’s why it’s so important that a person completing enduring documents has time and the opportunity to make informed decisions about their choice of attorney and their wishes and preferences for the future.

Recommendation 4–13 of the Australian Law Reform Commission Elder Abuse—A National Legal Response, ALRC Report 131 states that completing documents such an Enduring Power of Attorney shouldn’t be a requirement of entry to a residential aged care facility, and the OPG supports this position.

However this isn’t current legislation, so if your facility requires these documents, we encourage you to ensure residents are not rushed into completing them because this may lead them to make a poor choice or be coerced by a controlling relative, leaving them vulnerable to future abuse.

It’s also important to understand that if an adult has already lost capacity they cannot complete an Enduring Power of Attorney or Advance Health Directive. If a resident is in this situation and a decision needs to be made which can’t be made using informal decision-making support, the appropriate course of action is to apply to the Queensland Civil and Administrative Tribunal (QCAT) to have a guardian and/or administrator appointed.

More resources for employees of residential aged care facilities

Online education modules from Queensland Health

Designed for Queensland’s aged care workers, these online education modules provide information about substitute decision making and how to assist someone with advance care planning.This training focuses on health decisions, although many of the principles covered apply to financial and personal matters. Each module takes about 15 minutes to complete.

Elder abuse information sessions

Aged and Disability Advocacy Australia (ADA Australia) offers free elder abuse prevention information sessions to groups of older people and service providers in the greater Brisbane area. These aim to increase awareness of elder abuse in the community and residential care. Contact ADA Australia for details.