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‘Serious transparency problem’ in aged care’s VAD access
A report found most facilities do not provide information on or access to VAD, with a GP expert saying the gap ‘warrants attention’.
The residential aged care system is ‘failing older Australians’ in access to, and information on, voluntary assisted dying, according to a new report.
The residential aged care sector remains ‘slow to respond’ to the introduction of voluntary assisted dying (VAD).
This is according to Go Gentle Australia (GGA), in its annual ‘report card’, Voluntary Assisted Dying in Residential Aged Care Homes.
The end-of-life advisory group’s study into 70 of Australia’s largest aged care providers, across 130,000 beds, found 73% of the providers surveyed either do not offer VAD or have unclear access policies, with only 10% offering comprehensive information and full access.
Further, it found many providers have not improved their practices, despite rating poorly last year.
A case study in the report also recounts the story of one Victorian woman, Susie, whose mother was not permitted by her aged care facility to be visited by a VAD-approved GP for assessment.
This forced Susie’s family to transfer their mother back to hospital for assessment, where she was eventually able to access VAD three weeks later.
‘While we were grateful she was able to request her final wish, rather than having to wait until her body failed, the aged care home made it very hard for all of us,’ said Susie.
GGA describes the new report’s findings as ‘disappointing’, given it worked with providers to support improvements, which included directly contacting each provider a minimum of four times and giving them 12 months to respond.
Dr Anthony Marinucci, Chair of RACGP Specific Interests Aged Care, said the report identifies a ‘serious transparency problem in residential aged care that warrants attention’.
‘Residential aged care is a person’s home, not just a service,’ he told newsGP.
‘Older Australians and their families should know, before entering a home, what end-of-life options will be supported.
‘Transparency is not advocacy for or against VAD. It is basic informed consent and good clinical governance.’
GGA chief executive Dr Linda Swan said the report shows the residential aged care system ‘is failing older Australians’.
‘People entering aged care need to know which health services will be available for them and they need to know that their end-of-life choices will be respected and supported,’ she said.
‘However, far too many aged care homes do not provide this simple information.
‘This is a core obligation under the Aged Care Act and this lack of transparency and inaction raises serious concerns about how these facilities are supporting their residents’ legal right to access VAD.’
The report also found:
- some providers conflating VAD and suicide
- some large providers are making public statements that do not recognise VAD as a ‘medical treatment’
- one facility providing a VAD policy still containing placeholder text
- an outdated 2019 blog post being the only VAD information on one provider’s website.
The report also found that when providers did publish public VAD information, it was often not user-centred, using overly technical and legal language, and ‘asserts the beliefs’ of the provider rather than offering a clear explanation of VAD.
According to the RACGP’s VAD position statement, the college supports patient-centred decisions in end-of-life care, and ‘respects that this may include palliative care and requests for VAD’.
Dr Marinucci said while providers and clinicians may hold their own conscientious objections to VAD, ‘this should never translate into a resident being denied information, delayed, or transferred unnecessarily’.
‘The Aged Care Quality and Safety Commission is explicit: even providers that do not directly participate in VAD must still support access to medical services, including VAD,’ he said.
In 2017, Victoria became the first jurisdiction in Australia to legalise VAD, which came into effect in 2019, with many other jurisdictions soon following.
Yet in the GGA report, Victoria, along with Western Australia (the second state to pass VAD legislation) both show the lowest quality of VAD information in aged care homes, with just 10% considered ‘comprehensive’, compared to South Australia and Tasmania, which both top the table at 30%.
To accompany the report, GGA has launched a
searchable database to enable people to see how aged care homes support VAD in quality of information and access, featuring a simple traffic light system of green, amber and red, based on individual facilities’ responses.
Dr Marinucci said approximately 82% of Australians who access VAD have also accessed palliative care.
‘A VAD request should trigger more care, not less,’ he said.
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