Updated: Feb 4, 2021
Choice vs Risk, good question! It’s one of the most asked questions and considered a burning question in the industry since the new 8 Aged Care standards were implemented.
So, let's explore this topic!
Firstly, this topic is under Standard 1 (Resident dignity and choice) – the consumer must be treated with dignity and respect and can maintain their own individual identity. The consumer can make informed choices about their care and services and live the life the consumer chooses. The organisation must support each consumer to exercise choice and independence.
This also includes ensuring and providing evidence that the consumer can make decisions about their care and the way care and services are delivered, make decisions about when family, friends, carers or others are to be involved in their care, communicate their decisions and make connections with others and maintain relationships of choice including intimate relationships.
Moreover, the consumer must be supported to take risks to enable them to live the life they choose.
While the organisation respects and acknowledges consumers’ choice and their right to take risks, we as clinicians have a duty of care to ensure our consumer’s safety. We must conduct both comprehensive and risk assessments to identify the consumer’s assessed care needs, their functional ability and cognitive function to make the decision and understand the consequences if the choice they make has a negative impact to self or others. Both organisation and consumer (including chosen representative) must work together to look for solutions that are tailored to help the consumer to live the way they choose and not be harmful to self and or others.
We, clinicians still have the duty of care to maintain their safety, optimise their health well being and provide their assessed care needs. If the choices made by our consumers are harmful to themselves or others, we have to ensure that the consumer understands the risks, negative outcome or impact to their health (to others if applicable) and how the risks are detrimental to their current function. We have to provide genuine alternative options to support their choice which maintains their safety, not causing harm, least restrictive of their choice and still addressing their assessed care needs.
Also, we have to provide all information available to support the consumer to come up with solutions supporting their choice. Solutions must be best evidenced-based practice and ensure best quality care is provided.
Now, I am sure everyone who reads this has follow up questions relating to cognitive capacity to make decision/choice – if we have assessed the consumer to have cognitive impairment and cannot make choice, the consumer may have the court or tribunal-appointed guardian or EPOA to make choice on their behalf.
If in case the consumer has a language barrier or cannot communicate accurately their choice, then we have to include additional support to the consumer to communicate their choice clearly.
Lastly, how can we relate this to ACFI – the organisation should discuss their assessed long-term care needs and how they are beneficial to the consumer and have an agreeance about the outcome of the ACFI assessments as these will be reflecting to consumer’s care plan.
So let's do a recap, the organisation and consumer must work together closely – this means case conferences and regular meetings with the consumer and representatives to come up with the best way to address consumer’s choice while maintaining their safety, providing the assessed care needs, optimising their health, not causing harm to self/others and to be able to live their lives the way they choose.
After all, “care is in the details”
8 Years in Aged Care (and counting!)