NSW, NT prepare for advance care planning

The NSW government has released a five-year plan outlining moves towards better end of life care by using advance care planning, which will see changes made to aged care, hospital admissions, clinical reviews and discharge procedures as well as the incorporation of advance care plans in all electronic health records.

The government's Advance Planning for Quality Care at End of Life Action Plan 2013–2018 is aimed at normalising advance care planning and improving end of life care by integrating patients’ wishes into and throughout the management of chronic life-limiting illness.

It aims to do this by promoting routine advance care planning for residents of aged care facilities, developing tools that help patients and health professionals document decisions made during advance care planning conversations.

It also aims to change routine admission, clinical review and discharge procedures so that prior advance care plans are recognised, used in clinical decision making, and transferred between acute, community and aged care settings.

As part of the strategy, NSW Health will work with Medicare Locals, local health districts (LHDs), aged care services and with the Commonwealth, in particular in relation to incorporating advance care planning into the national PCEHR and enhancing its uptake in residential aged care facilities.

The strategy will see LHDs and specialist health networks work on developing admission procedures that routinely include identification of prior advance care planning. They will also work with shared services division HealthShare NSW on ensure advance care directives, advance care plans and acute resuscitation plans are flagged in medical records, patient data systems and electronic medical records.

The NSW Ministry of Health will be responsible for promoting the use of advance care plans and directives in the PCEHR, and it will work with LHDs and HealthShare NSW on advocating for information system capacity to support electronic transfer of advance care planning documents between primary and acute care.

In a forward to the plan, NSW Health Minister Jillian Skinner said she encouraged everyone to take the opportunity to develop their own advance care plan and share it with families and others who will be involved in their care.

She also urged people to “incorporate it into their individual medical records and thereby, hopefully, be able to face their inevitable passing, with a greater degree of calm confidence that they are in control and that this inevitable process has not robbed them of the freedom to make decisions about their own lives”.

The Northern Territory government is also working on what it is called advance personal planning, releasing an issues paper (PDF) and draft legislation to allow adults to make decisions about their future needs should they lose the capacity to make their own decisions.

The legislation will be essential to allowing NT residents to upload advance care directives to the PCEHR, as there is no current legal standing in the Territory for advance care planning or a person's nominated representative should that person be no longer able to make decisions for themselves.

NT Attorney-General John Elferink said the legislation will establish clear principles to ensure that decisions made on a person’s behalf are made in the adult’s best interests and comply with the wishes of that person.

“This bill ensures Territorians will have their personal decisions valued, allowing them to always be at the heart of decision making with matters relating to their future,” Mr Elferink said.

The bill will address three key matters once a person becomes incapable of making their own decisions. These include Advance Consent Decision, which is defined as an advance personal plan with direction about future health decisions made on a person’s behalf. This covers all healthcare including health services, emergency treatment and palliative care.

The bill also enables an Advance Care Statement, which outlines a person’s views, wishes and beliefs as the basis on which a person will make decisions on their behalf; and who can be appointed as a decision maker to make decisions on a wide range of matters including property, financial affairs, health and other lifestyle matters.

“This legislation seeks to provide Territorians with a voice about their future life management decisions, providing similar rights to those existing in other Australia jurisdictions,” Mr Elferink said.

Under the proposed bill, legal issues and matters relating to advanced personal planning can be resolved through the local courts.

Posted in Aged Care

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