Embedding Supported Decision-Making in Aged Care Services

A couple of years ago my mum was going through a period of ill-health.  She needed assistance to prepare meals at home and because I live interstate, I started exploring options to help from a distance.  My mum had met with an Aged Care Assessment Team previously, but she was unsure about the outcome of their assessment, so she asked me to call My Aged Care to clarify the situation. 

After explaining the situation, the My Aged Care staff member told me I needed to become my mum’s representative to be able to access her personal information.  As mum had asked me to do this, I went ahead providing my details over the phone.  At the end of a lengthy process, the My Aged Care staff member put me on hold and rang my mum to obtain her consent.  Moments later, I was told my mum had said NO and had not provided consent.  I ended the call feeling confused and embarrassed.  What I didn’t realise was that the role of regular representative would have enabled me to make decisions FOR my mum.  This was NOT what she or I had wanted. I was seeking to help her navigate what is a complicated process, not act on her behalf.

A new role for supporters

From 1 November 2025, the new Aged Care Act created a new role for supporters.  People receiving aged care services in Australia are now able to register one or more supporters to help them understand, consider and communicate their decisions.  If my mum chooses to make me a Registered Supporter, I will be able to request, receive and access her information but not make decisions on her behalf.  As a Registered Supporter I would be required to act in accordance with the principles of supported decision-making[1].  So, what does that mean? 

Providing decision support

Supported decision-making is the process of providing practical assistance with decision making to people who want and need support.  For my support to align with the principles of supported decision-making, my assistance needs to:

·       Assume the person can make decisions with the right support,

·       Ensure their will and preferences (i.e. who they are and what they want) guides the process,

·       Be tailored to their needs and preferences as well as the situation,

·       Be free from undue influence and coercion,

·       Enable risk by exploring and reducing harm in ways that stay true the person’s will and preferences,

·       Strengthen relationships and expand opportunities for decision making, and

·       Reflect on the outcome of the decision and the support provided.

Good decision support needs to be free of coercion and undue influence.

Supported decision-making is a legal and practical alternative to substitute decision-making - when others make decisions on a person’s behalf.  As people age and experience cognitive decline, their legal right to make decisions can be removed through Powers of Attorney and Enduring Guardianship mechanisms.  Historically this has meant when older people become unable to make decisions independently, they become excluded from the decision making that shapes their lives. 

Strengthening decision-making capability

When we take a supported decision-making approach, we seek to increase a person’s capability, rather than make a judgement about their capacity. There is a formula I recommend supporters remember,

ability + supports and accommodations = decision-making capability[2]

If a person’s cognitive ability declines over time supporters can strengthen their capability by, for example, making information simpler and more accessible, taking more time and paying attention to non-verbal expressions of preference.   

Even if substitute decision making becomes necessary at the end of life, we can be guided by the person’s will, preferences and rights rather than our subjective belief of what is in their best interest.

We all have a role changing the system

Our aged care system is undergoing a paradigm shift, putting older Australians in the driver’s seat of the services they receive.  Providers are required to treat people as unique individuals with important rights[3].  First among those rights are furthering people’s independence, autonomy, empowerment and freedom of choice[4]. 

To realise these rights, supported decision-making must be embedded into the fabric of aged care services.  Staff of home based and residential aged care services need to become skilled at providing decision-making support.  In addition, families and carers must become educated about what supported decision-making is so that they can share valuable context about their loved one’s needs, goals and preferences and better advocate for their rights.   

The change at the heart of this aged care reform is the responsibility of all of us – together we can ensure the people we love have dignity, respect, autonomy and choice as they age.

Illustration by Jeffrey Phillips

[1] Aged Care Act 2024 (Cth) 1,6. 

Supporters may be registered to assist individuals with navigating the system and are required to act in accordance with principles that promote supported decision making.

 [2] This formula comes from Michael Bach and Lana Kerzner’s paper A new paradigm for protecting autonomy and the right to legal capacity prepared for the Law Reform Commission of Ontario in 2010.  Important references to the concept of decision-making capability can be found on pages 67, 72 and 160.

[3] Aged Care Act 2024 (Cth) 3, 25(2)

The Commonwealth aged care system supports the delivery of funded aged care services by registered providers that:

 (a) puts older people first; and

 (b) treats older people as unique individuals; and

 (c) recognises the rights of individuals under the Statement of Rights.

[4] Aged Care Act 2024 (Cth) 3, 23 (1).