The decision to lodge an application to VCAT for the appointment of a guardian of last resort should only be made if you and the treating team are satisfied that an older person has a disability that is impacting on their ability to make an informed decision, and when:
- a decision needs to be made
- there is a conflict about the nature of this decision
- you have trialled all least restrictive alternatives.
The application process
In many Victorian hospitals social workers are the 'applicant' and coordinate the application process. This includes:
- completing the application form and an accompanying report
- seeking advice from the OPA Advice Service
- discussing the decision to proceed with the application with the older person and their family and carers
- requesting reports from the treating doctor and other relevant clinicians.
Application forms can be completed and lodged on the VCAT website and downloaded as an alternative if required.
As the applicant, it is essential that you provide the correct contact details for yourself and any interested parties, to ensure that the hearing is listed within the specified 30-day period and that the appointed guardian contacts the relevant parties as soon as possible.
Use the medical report form provided on the VCAT website to describe:
- the reason for admission, medical history and current functioning, including
- previous admissions to hospital
- nature of the decision-making disability
- how this is affecting the decision that needs to be made
- the trajectory of the admission, treatment provided, the person's ability to participate in their care routing and the level of support they require
- your recommendation.
Examples of the information required in the medical report is provided in Mrs Brown's case study.
Social work report
Each person’s situation will be unique. As the application form has minimal space to provide the VCAT member with the relevant context, you may need to provide a separate report to support the application.
There is no universal template to guide this process; however, it would be helpful for the VCAT member if you provided as much relevant background information as possible, including the following:
- What is the reason for admission? Outline the person's medical history and current functioning, including
- previous admissions to hospital
- nature of the decision making disability.
- What is the trajectory of the admission, treatment provided, the person's ability to participate in their care routine and the level of support they require?
- What is the reason for lodging the application?
- What decision needs to be made?
- If the issue is long standing, describe the history and what attempts have been made to address the issue.
- Describe the person's usual living arrangements.
- Do they own their own home?
- Are there any relevant cultural, language preferences and values?
- Do they live by themselves or with others?
- Who is in their family/support network and what is their opinion of the reason for the application?
- Outline if the person has been receiving services.
- Determine if the person has an advance care plan or an advance statement.
- If there is conflict between parties, describe what attempts have been made to negotiate and mediate these issues. What are the risks?
- Is there a risk of harm?
- What level of supervision does the team believe the older person requires?
- Can these risks be minimised with formal services or informal supports?
- What least restrictive attempts have been made to mitigate the risks?
- What has been done to optimise the person's functioning while they are in hospital?
- Include physical therapy/retraining, education to the older person and their family/carers, psychological and emotional support that acknowledges and assists the older person and their family and carers with the process of adjustment.
- Has an occupational therapy home visit occured? Have assistive devices been considered and trailled?
- Have you spoken to the OPA Advice Service? If so, document their advice.
- What does the treating team recommend?
- What will the appointment of a guardian achieve?
- Specify what decisions the team believe need to be made. This can include accommodation, access to services, access to the proposed represented person and medical, dental and other healthcare treatments.
- Why are you recommending that OPA be appointed as guardian of last resort?
An example of a social work report is provided in Mrs Brown's case study.