The complexity of decision-making in dementia care

Jul 16
Author:Sue Field
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A diagnosis of dementia does not mean an individual loses the right to make decisions for themselves. However, as the disease progresses, there may be limited or diminished mental capacity, making decisions about personal, health and financial matters difficult.

If older people lose mental capacity, these decisions may need to be made for them. In other words, a substitute decision maker may be required. Therefore it is crucial that older people have access to the knowledge surrounding adequate and appropriate substitute decision making tools.

Substitute Decision Making

However, it would appear that thinking and planning for the possibility of cognitive decline (and the financial consequences of this) is not common practice. Consequently, as far as can be ascertained, only a small proportion of people have in place a formal substitute decision making tool related to financial decisions.

Substitute Decision Making (SDM), that is making decisions on behalf of someone else, is governed by state and/or territory legislation. SDM can be for personal and health matters, and in NSW this is governed by the Guardianship Act 1987, or it can be for financial matters, which are governed by the Powers of Attorney Act 2003.

However, when appointing a substitute decision maker for financial matters it is argued that there are four essential criteria that the proposed attorney must meet. These will be discussed in my presentation at the Strengthening Dementia Services conference.

Role of the decision maker

The recent Cognitive Decline Partnership Centre (CDPC) study involving financial institutions and powers of attorney highlighted many of the problems associated with substitute decision making. Generally these problems related to the current legislation, the lack of harmonisation between the jurisdictions and the absence of any form of registration process – either federal or state/territory – and a general lack of awareness associated with substitute decision making.

Notwithstanding the appointment of a substitute decision maker for financial matters, this person cannot automatically make decisions of a personal and/or health nature for the person with cognitive impairment – a fact not readily understood by many in the community. My presentation will highlight specific issues associated with the role of the substitute decision maker for personal and/or health matters – and offer possible remedies to address the perceived short-comings associated with this vitally important aspect of planning for the future.

Criterion’s series of Aged Care conferences cover topics including Choice & Control, Dementia, Retirement Living, Residential Aged Care and more. View upcoming events here.

Aged Care conferences


Submitted by Sue Field

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