What is the outcome that needs to be achieved?
Older people can exercise choice and make decisions about their care and services, with support when they want or need it. Older people are provided timely*, accurate, tailored and sufficient information, in a way they understand. Older people are supported to exercise dignity of risk* to achieve their goals and maintain independence and quality of life*.
Actions
The provider implements a system to ensure information given to older people to enable them to make informed decisions about their care and services:
- is current, accurate and timely
- is plainly expressed and presented in a way the older person understands.
The provider implements a system to ensure that older people give their informed consent where required for a treatment, procedure or other intervention.
The provider implements a system:
- to ensure older people who require support with decision making are identified and provided access to the support necessary to make, communicate and participate in decisions that affect their lives
- that involves family and carers in supporting decision making where possible
- that uses substitute decision makers only after all options to support an older person to make decisions are exhausted
The provider supports older people to access advocates of their choosing.
The provider supports older people to live the best life they can, including by understanding the older person’s goals and preferences and enabling positive risk-taking that promotes the person’s autonomy and quality of life.
The provider records, monitors and responds to changes to the older persons quality of life.
Why is this outcome important?
Outcome 1.3 explains providers’ obligations to support older people in exercising their choices, independence and quality of life*. Outcome 1.3 is relevant to, and supports, all other standards. To meet Outcome 1.3, providers and workers need to understand each older person so they can deliver person-centred care*.
Supporting older people’s right to make informed choices and decisions about their care and services is key to Outcome 1.3. It also helps empower older people to maintain their independence and quality of life*. Providers should provide information in ways that meet the older person’s needs. This can be through:
- accessible formats
- translation services
- extra time to process information.
Providers need to understand each older person’s language and communication needs and preferences.
Effective communication supports dignity of risk* and helps people to give their informed consent*. Outcome 1.3 makes sure providers support older people to take part in activities that improve their independence and quality of life*.
Dignity of risk* acknowledges that older people have the right to make informed choices and decisions, including decisions involving some risks to achieve their personal goals and maintain their wellbeing*. This can help providers create a person-centred* environment that respects the older person’s needs, goals and preferences*, independence and choices. This in turn improves the older person’s quality of life*. Using supported decision-making* helps older people make complex choices. It makes sure their voices are heard, even when a supported decision maker or substitute decision-maker* is involved. Outcome 1.3 supports older people to make informed decisions and use substitute decision-makers* only after all options to support an older person to make decisions are exhausted.
Respecting informed consent* helps make sure older people have accurate and relevant information about their care. Before any changes are made to an older person’s care, providers need to give older people information about the change. Providers also need to give people time to think about, consult and make a decision based on their needs and preferences. This makes sure older people can be involved in their care and services and supports their dignity and right to personal choice. Outcome 1.3 shows that it’s important to support older people to use advocates and involve family and carers in making decisions, if they want to. Older people’s choices should always be considered. This encourages a balanced approach to risk, safety and independence.
You need to give focus to:
- informed consent*
- supporting older people to make informed choices and decisions about their care and services
- identifying older people who need supported decision-making*
- using substitute decision-makers* only after all options to support an older person to make decisions are exhausted
- making sure older people have access to advocates.
Key tasks
Providers
Providers
Put in place a system* to provide information to older people.
Integrate this system* with your organisation’s:
- information management system* and clinical information system* (Outcomes 2.7 and 5.1)
- communication system* (Outcome 3.3)
- risk management system* (Outcome 2.4).
Make sure the system* for providing information to older people includes information about how you support them to make informed choices. This includes information about dignity of risk* and positive risk-taking. Risks are considered ‘positive’ if they encourage an older person’s independence and improve their quality of life*.
Make sure the information you give to older people is current and accurate. Make sure you share information in a timely* way with older people and others involved in their care and services, including:
- family
- carers*
- workers
- health professionals*.
You need to share information in a way that meets each older person’s language and communication needs and preferences (Outcome 1.1). This may include using:
- simple, plain language and avoiding medical jargon
- inclusive formats to give older people information if they have communication barriers*, such as using large text or images
- language services. For example, interpreters and translators for older people:
- from culturally and linguistically diverse (CALD) backgrounds
- from Aboriginal and Torres Strait Islander backgrounds
- who are deaf, hard of hearing or deafblind.
Make sure older people understand the information you give them. Give them time to think about the information if they need it. This will help older people, their family and carers* to make informed decisions about their care and services.
Put in place a system* to get informed consent* from older people.
You need a system* that clearly explains:
- situations where you need to get informed consent*. You need to get informed consent* before an older person receives a clinical care* treatment, procedure or other intervention. This includes changes to their care and services. For example, when:
- there are changes to fees and charges they have agreed to in the past (Outcome 1.4)
- you need to collect use, store, or share older people’s information (Outcomes 2.7, 3.1, 3.3, 3.4 and 7.2)
- you’re considering clinical interventions such as restrictive practices* or escalating an older person to medical or emergency services (Outcome 3.2).
- how to find out if an older person needs help to make decisions. This system* needs to explain how the older person can be supported if they need it. This includes access to advocates they want.
- how you support older people to make informed choices and take positive risks
- how you support older people with dignity of risk* (Outcomes 3.2 and 5.4). This includes risks that may be harmful to them, such as smoking.
- how you explain dignity of risk* and how it’s understood by the older person, their family and carers*.
- where older people haven’t given you informed consent* . You need to explain the steps workers should take to understand why and if the organisation can provide more support to help the older person make a decision. Depending on the conversation, document this in your information management system* (Outcome 2.7).
The guidance for Outcomes 3.2 and 5.4 has more information on dignity of risk* and decision-making.
The guidance for Outcomes 6.1 and 6.2 has more information on dignity of risk* for eating and drinking. This includes eating and drinking with acknowledged risk (EDAR)*.
Make sure that your systems* for planning and delivering care and services include the right people. This means making sure that you think about all people who the older person wants to be involved in the decision-making process.
When doing assessment and planning, including comprehensive care* planning and advance care planning* (Outcome 5.4), use the systems* for planning and delivering care and services to:
- find out if an older person needs support to make decisions. Document this information. Help the older person get the support they need to make, share and take part in decisions that affect their lives. If the older person wants an advocate to support them, help the older person find an advocate.
- identify which family and carers* the older person wants to be involved in making decisions. Make sure:
- all relevant people are involved in future decisions
- substitute decision-makers* are only asked to make health, medical and residential decisions for an older person if they lose their decision-making capacity
- you keep records.
- find out the older person’s needs, goals and preferences*, so they can take positive risks. This supports the older person’s independence and quality of life*. Make sure that dignity of risk* is clearly shared with and understood by older people and those making decisions.
- monitor changes to the older person’s quality of life*. Take steps to manage and resolve any issues. Document this information in the older person’s care and services plan* and progress notes.
Older people in residential care homes need different processes for assessing, monitoring and supporting their quality of life* to people receiving home care. For residential care home providers, the guidance for Outcome 7.1 has more information on how you can support an older person’s independence and quality of life*.
Systems* for planning and delivering care and services need to be clear on what an organisation defines as a decision. This will depend on the type of care and services you deliver. This helps workers, older people, their family and carers* understand when to follow your process* for making decisions. For example, when the organisation or workers need to have formal conversations with older people or their substitute decision-maker* or both.
The guidance for Outcomes 3.1 and 5.4 has more information on assessment and planning.
Make sure workers have the time, support, resources and skills to help older people to make decisions about their care and services.
Give workers guidance and training on how to support older people to make decisions about their care and services (Outcome 2.9). This needs to be in line with:
- the organisation’s policies* and procedures*
- contemporary, evidence-based practice*
- workers’ roles and responsibilities*.
Make sure workers understand how to:
- use the organisation’s systems* to share information with older people
- get informed consent* from the older person
- involve the right people in making decisions
- correctly document each of these steps.
The guidance for Outcomes 2.8 and 2.9 has more information on workforce planning and worker training.
Monitor how you deliver care and services to make sure workers help older people to make decisions about their care and services.
Make sure your workers are following your:
- information management system* (Outcome 2.7)
- clinical information system* (Outcome 5.1)
- communication system* (Outcome 3.3).
To check if workers are helping older people to understand their dignity of risk* and make decisions, you can review:
- older people’s care and services (Outcome 3.1). For example, care and services plan* s and progress notes.
- complaints* and feedback* (Outcome 2.6)
- information about incidents* and near misses* (Outcome 2.5).
Look for situations where workers haven’t:
- supported the older person to make informed choices or decisions
- supported the older person with dignity of risk*
- provided information in a way the older person can view or understand.
Also, talk with older people, their families and carers* about the care and services they receive (Outcome 2.1). Ask them about how workers have supported them to make choices. Ask them if the information workers have given them has been in a way they can view and understand. These conversations can then inform continuous improvement* actions and planning (Outcome 2.1).
Assess if workers are following your quality system* (Outcome 2.9). You can do this through quality assurance and system* reviews.
If you find issues or ways you can improve through your reviews and assessments, you need to address them. If things go wrong, you need to:
- practise open disclosure*. This means being open about what has gone wrong. Share what went wrong with older people, their family and carers*.
- put in place strategies to mitigate the risk of things going wrong again.
The guidance for Outcome 2.3 has more information on monitoring the quality*.
