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.
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.