Three in four aged care providers aren’t meeting their legal obligations to offer VAD or provide information on how to choose it, a new report says.
Almost three quarters of aged care providers in Australia either don’t offer voluntary assisted dying or don’t provide clear information to residents on how to access it, despite federal obligations to do so under the new Aged Care Act.
And two thirds of residential aged care homes do not provide any public information about VAD in their facility or on their website, according to a new report from Go Gentle Australia.
Only 10% of providers supply comprehensive information and full access to VAD, which is legally available in every state and the ACT.
Under the Aged Care Act, aged care residents have the right to choose VAD and have their choice respected.
“Older people have a legal right to know all their end-of-life options, including the choice of VAD. And they have a right to this information before they choose a facility to become their home,” the report said.
“Older people can rightly expect that the people who run residential aged care facilities will adhere to statutes and guidelines put in place to protect their choices and rights.”
The Aged Care Quality and Safety Commission warns that providers that choose not to take part in VAD must still meet their legal obligations to support residents’ access to VAD.
The Go Gentle report includes 70 providers with 130,000 aged care beds, making up 66% of residential aged care providers.
The report found that 73% of those providers did not offer VAD access to residents, or VAD access was unpublished or unclear.
And 66% of providers did not provide clear, plain-language information about VAD either publicly in their facilities or on their websites.
“Most residential aged care homes do not routinely provide clear, publicly accessible information about VAD, resulting in older people entering a service without knowing whether their end-of-life decisions will be respected,” the report says.
Among the 25 largest aged care providers in Australia, Opal Healthcare, Bolton Clarke and Estia were given ratings of “Urgent action required: Publish comprehensive public VAD information”.
But Regis, Bupa and Uniting NSW/ACT were each rated as a “best practice provider”.
TMR contacted Opal Healthcare, Mercy Health, Calvary Aged Care, Bolton Clarke and Estia for comment, but none responded before deadline.
The worst performing providers were in Victoria and Western Australia, despite those states being the first to pass VAD laws.
Go Gentle Australia CEO Dr Linda Swan said the report showed that the system was “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.”
Dr Swan said Go Gentle looked at the experience of trying to access VAD in aged care from an older person’s point of view.
“For too many institutions, the experience is woefully inadequate,” she said.
Older Persons Advocacy Network (OPAN) CEO Craig Gear said the lack of transparency “must change”.
“It should not be controversial to say that all of us – no matter where we live – are entitled to choose the end-of-life care that is right for us. Where legal, this includes voluntary assisted dying,” Mr Gear said.
“Too often, older people enter residential aged care without knowing whether their end-of-life decisions will be respected.”
Related
The researchers gave aged care providers 12 months to respond to questions about VAD access in their facilities and make improvements, but 44% of providers did not respond after that time – even after at least four direct requests.
While faith-based providers were three times more likely than other providers to refer to VAD on their websites, that information often focused on their non-participation in VAD and some stated an explicit opposition to VAD, the report says.
The report says restricting access to VAD causes harm to older people by:
- delaying access to VAD by restricting access to clinicians or forcing residents to leave the premises to take VAD medication;
- reducing choice around where and when VAD medication is delivered;
- and increasing the emotional burden on residents and carers because of a sense they are “doing something wrong” because the institution reinforces harmful stigma.
According to the ACQSC, living in a residential care home does not impact a person’s right and ability to choose VAD.
“This is true even where the provider has made the decision not to participate in the VAD process, and in jurisdictions where there is no obligation for a provider to directly facilitate access to VAD services,” the report said.
Even though the ACQSC does not regulate a provider’s decision to take part directly in the VAD process, a provider that decides not to take part will still have to meet its provider obligation to support older people’s access to medical services, including in relation to VAD.
“Providers must also support an older person’s right to exercise choice and autonomy in relation to the care they receive,” a factsheet by the ACQSC said.
“Importantly, a person receiving aged care shouldn’t be disadvantaged if they live in a residential care home and want information about and/or access to VAD.
“Enabling a person receiving aged care to access VAD under state and territory laws is consistent with a provider’s obligations under Commonwealth law to support a person’s choice and their right to be treated with dignity and respect and to safe, fair, equitable and non‑discriminatory treatment.”
Providers have federal obligations to make sure that older people’s choices are protected under the Aged Care Act 2024 (Cth) and guidance from the Aged Care Quality and Safety Commission, as well as state VAD laws (with Commonwealth law taking precedence over state legislation).
The Aged Care Act includes a Statement of Rights that says older people who are accessing aged care services have rights to:
- exercise choice and make decisions that affect the individual’s life
- be treated with dignity and respect
- receive safe, fair, equitable and non- discriminatory treatment
- have privacy respected and personal information protected
- equitable access to palliative and end-of- life care when required.
Read the full report here, including a VAD template for providers to use and a guide for consumers. You can also search for an aged care provider to see whether they support VAD.
