Important information about new policies and procedures at your loved one's aged care centre

6 September 2022

Dear family member/resident representative,

I am writing to let you know about two new policies and two new procedures that have been implemented at your loved one’s aged care centre:

• Dignity of Risk policy and procedure
• Mental Capacity policy and procedure

These policies and procedures have been designed to help us support your loved one to make informed choices about their care and services, while understanding the risks involved with any decision, and how they could be managed.

What do these terms mean?

• The concept of Dignity of Risk acknowledges that living a fulfilling existence comes with an element of risk, and champions the right of all individuals to choose to take risks when engaging in life experiences.
• Dignity of Risk also recognises that overly restricting an individual’s choices in order to eliminate risk will likely be at the expense of the person’s dignity, independence and wellbeing.
• The term Mental Capacity relates to a person’s cognitive ability to make decisions.
• The freedom to make one’s own decisions is a basic human right. However, some people do not have the mental ability to make certain types of decisions, so this must be assessed on a case-by-case basis.

Above all, IRT’s primary legal obligation to our residents, our employees and others in the care centre is a duty of care to keep everyone safe. These policies and procedures have been developed in collaboration with our Legal, Risk and Quality teams to ensure we meet legal requirements while respecting choice and your loved one’s right to make their own decisions.

What is changing? 

Mental Capacity assessments

• When your loved one makes a decision, there is a presumption in favour of their ability to make that decision (with or without support) and a decision-making capacity assessment will only be carried out where there is sufficient evidence to the contrary.
• It’s important to note that a substitute decision-maker is a person permitted by law to make certain decisions on behalf of another person, who either chooses not to make certain decisions for themselves or lacks the mental capacity to do so.
• It is possible for a person to have more than one substitute decision-maker, and that may be a different person to the one nominated as your loved one’s resident representative with your IRT aged care centre.
• Substitute decision-making will be used as a last resort and only when all efforts to assist a resident to make a decision for themselves have been unsuccessful.
• Where a substitute decision-maker is not documented, IRT will determine who this should be according to the law.

Dignity of Risk assessments

• Your loved one’s care team will now use a Risk Calculator to assess the level of risk a choice may impose and then determine if and how we can support that decision safely, and in a way that does not jeopardise our duty of care.
• If a decision poses risk, collaborative discussions with the resident or their substitute decision-maker will be held to identify risk mitigation strategies to minimise the risk as much as possible.
• A Dignity of Risk Assessment & Care Plan will be completed with each choice that poses risk. The plan will outline the risk rating, risk mitigation strategies and informed consent details. The plan will be shared with and signed by the resident or their substitute decision-maker to ensure all parties are in agreement.
• Where the risk score still remains too great after risk mitigation strategies have been implemented and it jeopardises our duty of care, IRT may choose to not support this choice.
• In this instance, the resident/substitute decision-maker will be informed and where they do not agree with our decision the Care Manager will discuss IRT’s formal escalation process to resolve the situation.

What happens now?

• You and your loved one do not have to do anything. All current risk activity plan information will be migrated to the new Dignity of Risk Assessment & Care Plan.
• Any new decisions made by your loved one that involve risk, will be assessed together with their care team in line with the new policies and procedures.
• Please speak to the Care Manager if you are unsure if a substitute decision-maker has been nominated for your loved one.

Where can I get more information?

If you have any questions or concerns, or would like to provide feedback, please speak to your Care Manager at your loved one’s aged care centre.

Yours sincerely,

Nia Briguglio
EGM – Aged Care Centres