This policy and procedure outlines Continuity Care ’s approach to encouraging and enabling participants/consumer/clients to make decisions, having regard for dignity of risk in relation to those decisions. It applies to all potential and existing Continuity Care participants/consumer/clients, their family members, carers and other supporters and meets relevant legislation, regulations and Standards as set out in Schedule 1, Legislative References.

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Independence and Informed Choice Outcome Each participants/consumer/client is supported by the provider to make informed choices, exercise control and maximise their independence relating to the supports provided. Indicators ·         Active decision-making and individual choice is supported for each participants/consumer/client including the timely provision of information using the language, mode of communication and terms that the participants/consumer/client is most likely to understand. ·         Each participants/consumer/client’s right to the dignity of risk in decision-making is supported. When needed, each participants/consumer/client is supported to make informed choices about the benefits and risks of the options under consideration. ·         Each participants/consumer/client’s autonomy is respected, including their right to intimacy and sexual expression. ·         Each participants/consumer/client has sufficient time to consider and review their options and seek advice if required, at any stage of support provision, including assessment, planning, provision, review and exit. ·         Each participants/consumer/client’s right to access an advocate (including an independent advocate) of their choosing is supported, as is their right to have the advocate present
Advocate – a person who assists a participants/consumer/client to express their needs, or who speaks on behalf of a participants/consumer/client. Advocates can be a family member, friend or an Independent Advocate. They are not substitute decision makers but are there to ensure the participants/consumer/client’s needs and wants are listened to. Independent advocate, in relation to a person with disability, means a person who: ·         is independent of the NDIA, the NDIS Commission and any NDIS providers providing supports or services to the person; ·         provides independent advocacy to assist them to exercise choice and control and have their voice heard in matters that affect them; ·         acts at the direction of the person with disability, reflecting their expressed wishes, will, preferences and rights; and ·         is free of relevant conflicts of interest. Child’s representative – a person responsible for acting and making decisions in relation to the NDIS Act 2013 on behalf of a child. It is usually a person with parental responsibility. However, in some cases it may be a legal guardian, a government agency or a person appointed by the NDIA. Court-appointed decision-maker - a person who, under a law of the Commonwealth, or a State or Territory, has guardianship of a participants/consumer/client or who is appointed by a court, tribunal, board or panel to make decisions for the participants/consumer/client. Decision making capacity - a person’s ability to make decisions about things that affect their daily life. This usually means that they are able to: understand the situation and the decision required; understand what the choices are; weigh up the consequences of the choices; understand how the consequences affect them; and communicate their decision. Dignity of risk - the right of an individual to choose to take some risk in engaging in life experiences. Nominee - a person appointed in writing, at the request of a participants/consumer/client, their guardian, or the NDIA, to act on behalf of, or make decisions on behalf of a participants/consumer/client. Under the NDIS, there are 2 types of nominee, a Plan Nominee and Correspondence Nominee. One person can be appointed as both and either type can be appointed indefinitely or for a specified term. Participants/consumer/client-appointed Decision-maker - a person who is able to make a decision on a participants/consumer/client’s behalf under a formal arrangement between that person and the participants/consumer/client (for instance, a Power of Attorney, an Advance Health Directive or an Enduring Guardian).
All staff must be familiar with the object and principles of the NDIS as set out in the NDIS Act 2013 (Cth). The following principles are particularly relevant to this policy and procedure: ·         people with disability should be supported to exercise choice, including in relation to taking reasonable risks, in the pursuit of their goals and the planning and delivery of their supports; ·         people with disability have the same right as other members of Australian society to be able to determine their own best interests, including the right to exercise choice and control, and to engage as equal partners in decisions that will affect their lives, to the full extent of their capacity; ·         people with disability should be supported in all their dealings and communications with the NDIA so that their capacity to exercise choice and control is maximised in a way that is appropriate to their circumstances and cultural needs; ·         the role of families, carers and other significant persons in the lives of people with disability is to be acknowledged and respected; and ·         where acts or things are done on behalf of a person or child with disability: o   they should be involved in decision-making that affects them, including making decisions for themselves, to the extent possible; o   they should be encouraged to engage in the life of the community; o   the judgements and decisions they would have made for themselves should be taken into account; o   their cultural and linguistic circumstances, and gender, should be taken into account; and o   their supportive relationships, friendships and connections with others should be recognised
Continuity Care is committed to ensuring all participants/consumer/clients are involved in making decisions and choices about all aspects of the support services they receive. Continuity Care works with its participants/consumer/clients on the presumption that they have decision making capacity. In the first instance, participants/consumer/clients should be the person making informed decisions and choices about the services they receive. If required, staff must support, and build the capacity of, participants/consumer/clients to make their own decisions. Staff must consider the participants/consumer/client’s Dignity of Risk and their own Duty of Care when supporting participants/consumer/clients to make decisions. Continuity Care recognises that a person’s decision-making capacity can be lost, temporarily or permanently, or regained and that even if a person lacks capacity with regard to some decisions, this does not mean that they lack decision-making ability in all situations. Continuity Care does recognise that some participants/consumer/clients will have a support person, representative, family member or advocate to assist them to make a decision or choice, or to make a choice on their behalf. They may also have a nominee, court-appointed decision maker and/or participants/consumer/client-appointed decision maker who is appointed to make decisions regarding certain aspects of their life or NDIS service provision.
To ensure participants/consumer/clients understand their rights regarding decision making, Continuity Care uses its Participants/consumer/client Charter, Participants/consumer/client Handbook and website to provide participants/consumer/clients, families, carers and all other stakeholders with information about this policy and procedure, in an easy to understand format. To ensure participants/consumer/clients understand this information, staff must provide information to them and their supporters or families in ways that suit their individual communication needs. Written information can be provided in [different languages and Easy English] or explained verbally by staff. Staff can also help participants/consumer/clients access interpreters or advocates where required. Staff must advise participants/consumer/clients or their representatives or families when making appointments for an initial assessment and subsequent reviews that they are entitled to have a support person at the meeting to assist them in the decision-making process. Staff will bring information in Continuity Care ’s Participants/consumer/client Handbook about independent advocacy and agencies that can assist with this process to the participants/consumer/client’s or family member’s attention. When requested by participants/consumer/clients or their representatives, staff must contact their advocates, support people or other representatives, giving them the day, date and time of meetings participants/consumer/clients would like them to attend. Staff must support participants/consumer/clients and their representatives to access any information they reasonably require enabling them to participate in decision-making. This includes supporting them to access technology, aids, equipment and services that increase and enhance their decision-making and independence. Staff must be responsive to the changing needs, goals, aspirations and choices of participants/consumer/clients and communicate in appropriate formats to facilitate their informed decision-making and choice. Staff must also recognise that the support a person needs to make a decision will vary it may decrease over time as people gain experience or confidence and may increase as the type of decisions become more important. Where Continuity Care is unable to meet the needs and goals of a participants/consumer/client, staff should refer the person to other relevant service providers as per the Providing Information, Advice and Referral Policy and Procedure. As per Continuity Care ’s Human Resources Policy and Procedure, all staff must undergo Induction, which includes training in responding to the needs of participants/consumer/clients, participants/consumer/client decision making, dignity of risk and assisting participants/consumer/clients to make informed choices. Staff knowledge and application of this policy and procedure is monitored on a day-to-day basis and through annual Performance Reviews. Additional formal and on-the-job training is provided to staff where required. Dignity of Risk Where a participants/consumer/client has the capacity for decision making and wants to try new things or continue with options that may not have gone well in the past, all options, risks and possible consequences must be discussed with them and all relevant stakeholders involved in the decision-making process. If a decision doesn’t place anyone at risk of harm, staff must comply with the participants/consumer/client's decision. Staff must recognise the opinions of those who are important in the lives of people with a disability. However, this should not compromise the right of the person with a disability to have the final say in their decision. Where there is disagreement about a decision based on a different view of the risk involved or the potential for harm, the emphasis should be on assisting the person to understand and obtain information about the risks and any mitigation. Important decisions where firm disagreement exists (between, for example, the person and their parents) must be referred to the Operations Manager, who may need to arrange independent mediation. Any staff member who believes they cannot agree with a person’s decision because of their own values should refer the matter to the Operations Manager. The staff member may need to withdraw from supporting the person in the particular activity. Access to supports required by the participants/consumer/client must not be withdrawn or denied solely on the basis of a dignity of risk choice that has been made by the participants/consumer/client. When a child does not need a child’s representative A child’s ability to make decisions on their own behalf increases as they develop and sometimes a child will not require their representative to make a decision on their behalf. For this to be the case, staff must be satisfied that the child is capable of making their own decisions, having regard to whether the child is able to: ·         understand the information relevant to the decision; ·         Use that information when making decisions; ·         understand the consequences of decisions they make; and ·         communicate decisions in some way. To determine whether a child can make certain decisions for themselves, staff must also: ·         consult with the child and the child’s representative; ·         consider the preferences of the child; ·         consider the need to preserve existing family relationships; and ·         comply with any existing legal guardianship arrangements in place.   Duty of Care Continuity Care and all staff must ensure that reasonable action is taken to minimise the risk of harm to anyone who is likely to be affected by supports they deliver. Continuity Care also has a duty to ensure a safe and healthy workplace for staff, the people they support and visitors. Some choices by people with a disability may potentially expose staff to risk, particularly with regard to Work Health and Safety. Staff must consider the risks and benefits of a decision and any strategies to reduce the impact of any risk. Any restriction of a participants/consumer/client’s choice or actions based on an unacceptable level of risk to the person, staff or others must be documented on the participants/consumer/client’s file, including the reasons and strategies considered to reduce or manage the risk. Where staff are unsure about whether a decision presents an unacceptable level of risk, they must consult the [Position Title]. Substitute Decision Making Informal substitute decision-making Informal decision-making is where a person making a decision on behalf of another person has not been legally appointed. People who can make informal decisions include the person’s family, friends, carer or nominated support. Most decisions can be made informally, including decisions about who a person wishes to see, their work, leisure, recreation, holidays or accessing services. Staff must ensure that all informal decision-making arrangements are clearly recorded on the participants/consumer/client’s file and communicated to other relevant staff. Decisions can then be pursued through the agreed informal arrangements. Formal substitute decision-making Formal decision-making arrangements must be implemented when informal decision-making is insufficient, such as when: ·         there is conflict over decisions being made about the person; ·         where specific legislative requirements exist (e.g. consent to medical treatment); or ·         where the person has a guardian or appointed nominee or decision maker. Formal arrangements should take a rights-based approach and consider the participants/consumer/client’s individual wishes as much as possible regardless of their impaired decision-making capacity. Staff must record and maintain information about formal decision-making arrangements on participants/consumer/client files. Any amendments to a person’s decision-making arrangements must be clearly recorded and communicated to relevant staff as soon as practicable. Staff must refer any issues relating to formal decision making to the Operations Manager. Supporting Documents Documents relevant to this policy and procedure include: ·         Participants/consumer/client Rights and Responsibilities Policy and Procedure ·         Privacy and Confidentiality Policy and Procedure ·         Service Access Policy and Procedure ·         Human Resources Policy and Procedure ·         Participants/consumer/client Charter ·         Participants/consumer/client Handbook Monitoring and Review This Policy and Procedure will be reviewed at least annually by the Continuity Care. Reviews will incorporate staff, participants/consumer/client and other stakeholder feedback. Continuity Care ’s feedback collection mechanisms, such as participants/consumer/client satisfaction surveys, will assess: ·         participants/consumer/client awareness of their rights and the extent to which they feel able and supported to exercise them; ·         participants/consumer/client satisfaction with Continuity Care ’s complaints processes; and ·         whether participants/consumer/clients are satisfied with the choices they are provided regarding their service delivery. Continuity Care ’s Continuous Improvement Register will be used to record improvements identified and monitor the progress of their implementation. Where relevant, this information will be considered as part of Continuity Care ’s service planning and delivery processes.
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