As we’ve discussed before, by 2037, one in five Australians will be age 65 or older. It’s only natural to wish for things to stay the same forever, and perhaps this tendency is one of the reasons why discussions about end of life planning are difficult, but necessary. NSW Trustee & Guardian offers a helpful guide to planning ahead, and they advise that everyone over age 18 make end of life plans for legal, financial, and health decisions.

Aged care involves open discussions between family members, older loved ones, and caregivers. Having a few conversation starters could be helpful to get some of the needed conversations started. Here are a few questions you may want to try to get discussions about end of life planning, elderly care, wills and estate planning, and more:

  • Have you thought about how you’ll manage if you can’t get around the way you can today?
  • How can we plan for our future at home?
  • If something should happen, who in our family can act on your behalf if necessary?
  • If you want to stay at home, what help do you think you’ll need?
  • Who might you want your (special things) to go to?

Advanced Care Directives: talking about and planning for health care and treatment

If your loved one should fall ill and become unable to communicate, it will be too late for them to tell you or caregivers what kind of care they want to have. Advance Care Planning Australia explains that the Advance Care Directive answers the question, “What would I want to happen if I couldn’t speak for myself?”

Navigating this topic with loved ones will be much easier if you phrase questions with the idea that by completing the directive, their wishes about their future health care will be followed.

One of the most important reasons to discuss and make an Advance Care Directive with your loved one is that it can only be made by an adult with decision-making capacity. The Advance Care Directive, once set, cannot be overridden by health professionals and family members who may feel differently. A valid Advance Care Directive protects a person’s wishes should they lose their ability to communicate or make decisions.

The Directive should include decisions about the following:

  • The person your loved one wants to make medical decisions if they’re unable to do so
  • Details about your loved one’s values, goals, and preferred outcomes
  • What types of levels of care are desired in emergencies or in situations of severe, progressive illness

Some questions to be asked and answered for the Advance Care Directive also include the type and level of care desired at the end of life or in an extreme health crisis. The Directive will also determine where your loved one wants to receive care during a terminal illness — for example, in hospital or at home. The Advance Care Directive form for NSW also includes spaces to write statements which could help family members to make decisions regarding care.

The time to make these choices isn’t when a serious health crisis occurs. Before such a crisis, the Advance Care Directive helps to clearly record values, beliefs, and choices.

Who will make important decisions about medical treatment?

The Advance Care Directive identifies a person who will be responsible for making treatment and care decisions if you or your loved one becomes incapacitated, formally called Enduring Guardianship. The Enduring Guardian serves as the decision-maker for medical treatment, including palliative care. Often, people choose a trusted person, such as a family member or close friend, to be the Enduring Guardian.

What are other health planning directives needed?

The Advance Care Directive can also cover the types of medical care desired in end-of-life circumstances such as desires for palliative care. Palliative care is a type of care that isn’t aimed at curing an illness, but instead seeks to support the patient and make them as comfortable as possible. Palliative care seeks to support the highest quality of life possible, including when there is little or no prospect of a cure.

The idea of palliative care has expanded and changed over the years. It is no longer exclusively offered in hospital settings near the end of life. Palliative care can be offered over a longer period of time, and can be offered through home care as well as in medical settings. In 2018, nearly 80,000 Australians received palliative care hospitalisations, but many more received palliative care through in-home services.

Another part of the Advance Care Directive involves ambulance providers. A person may decide through their Advance Care Directive that they do not want to be resuscitated or have other heroic efforts if they have a heart attack or stroke. Upon arrival, emergency medical personnel may ask if there is an Advance Care Directive. If it specifies no CPR, for example, they will not perform these services. Do not resuscitate (DNR) orders also fall under this area of end-of-life care planning.

Legal considerations:

Wills, estates, and power of attorney are all considerations for ageing adults, and though it’s not often thought about, also for younger adults, especially those with families. An individual’s estate encompasses their financial assets, property, and belongings.

NSW Trustee & Guardian advises that everyone should have a will, and they further advise that the will should be drawn up with the help of legal counsel. “Do it yourself” wills are often subject to challenges and can result in delays, NSW Trustee & Guardian says. The executor of a will should be a trusted person, most often a family member or friend, who will be responsible for overseeing the terms of the will, including distribution of funds and property.

About Power of Attorney

Power of Attorney is a separate role from the executor. While the executor is responsible for the terms of a will after someone dies, Power of Attorney refers to the ability to make financial and legal decisions for someone while they are still alive.

There are two types of Power of Attorney: ordinary and enduring. Ordinary power of attorney grants a person the ability to oversee financial affairs following your instructions. If you should lose capacity to make decisions, the ordinary Power of Attorney will not stay in effect. In this case, an enduring Power of Attorney is needed, but this decision must be made while a person still has the ability to choose the person they want to give enduring Power of Attorney. This is perhaps the most important consideration when selecting someone to manage financial affairs: the Enduring Power of Attorney should be a trusted and trustworthy person who is willing to undertake the responsibility.

Who can make decisions about living arrangements and medical care?

Individuals with Power of Attorney do not have the power to make medical or lifestyle decisions, however. These decisions are governed by the Advance Care Directive or by an Enduring Guardian. Enduring Guardians are able to make decisions about accommodation, health care, medical and dental consent, and which services are needed, such as home health aides or meal delivery service.

Where should these documents be stored?

NSW Trustee & Guardian says that many people store their wills, Advance Care Directives, and other legal documents at home in a drawer or cabinet. While it can’t hurt to have a copy on hand, the documents can be easily lost or damaged. You can provide copies of your Advance Care Directive to doctors and medical offices, and to trusted organisations like 365 Care. In addition, NSW Trustee & Guardian also offers safe-keeping services.

Sources

https://nationalseniors.com.au/news/latest/it-s-time-to-talk-about-your-parents-aged-care-needs
https://www.advancecareplanning.org.au/for-family-friends-carers/help-someone-make-an-advance-care-directive
https://www.advancecareplanning.org.au/resources/advance-care-planning-for-your-state-territory/nsw
https://www.advancecareplanning.org.au/docs/default-source/acpa-resource-library/acpa-fact-sheets/acpa_individuals-factsheet-online_aug2018.pdf?sfvrsn=1b8ce33c_18
https://www.health.nsw.gov.au/patients/acp/Pages/acd-form-info-book.aspx
https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia/contents/summary
https://emergencylaw.wordpress.com/2020/08/30/nsw-advance-care-directives-and-paramedics/