Clinicians are frequently required to make recommendations about the complex care needs of patients in preparing for their discharge. Sometimes this results in an application to the Guardianship list of the Victorian Civil and Administrative Tribunal (VCAT) for the appointment of the Public Advocate, as a guardian of last resort, for an older person in hospital.
Records from The Office of the Public Advocate (OPA) show that over 200 hospital initiated applications resulting in the appointment of OPA as a guardian of last resort are recorded annually, although the actual number of applications is most likely higher than this.1
People aged 65 and over with established cognitive impairment are the subject of the majority of these applications. They are often made in the context of a disagreement between the treating team and the older person about the type of accommodation or services that are required to meet the older person’s care needs on discharge.2
It can be a long process with the potential to have a significant impact on the older person’s levels of stress, autonomy and sense of control over their life. It may extend the older person’s hospital admission while they wait for a hearing, for a guardian to be appointed, and for a decision to be made and effected. An extended admission can play a significant role in increasing the risk of the older person experiencing functional decline in hospital, which in turn can further limit their ability to realise their lifestyle choices.3
Before deciding to pursue an application, a model of least restrictive practice should be employed. This includes working with the older person and their families or carers to avoid an unnecessary application, maximise their participation and improve care during this process. In this process it can be useful to weigh up the risks and benefits of the older person leaving hospital versus the risks and benefits facing the older person if they are to remain in hospital for a lengthy period of time. By employing a least restrictive model of practice you can work with your team to minimise the extent of any limitations on the person and encourage them to participate in all decisions that affect them.
1 Office of the Public Advocate, Annual report 2014-2015, 2015, Melbourne: Office of the Public Advocate.
2 Carter, B., Guardianship and the ageing population: profile of Victorian guardianship clients aged over 65 years, 2011, Melbourne: Office of the Public Advocate.
3 National Ageing Research Institute, Health Services Guardianship Liaison Officer Pilot evaluation, 2015, Melbourne: National Ageing Research Institute.