Transfers - Managing Risk


This section aims to support health professionals and care staff working in residential aged care to navigate transfers of residents receiving palliative care between different care settings and to identify and manage associated risks.

A factsheet has been developed for residents, their families and friends.

Key messages

  • People living in residential aged care facilities and home care sometimes want or need to transfer between care settings during the palliative phase.
  • Consent to transfer should be given by the person, or, if the person does not have capacity, their substitute decision-maker. When transfer is being considered:
    • health professionals and care staff should offer the person relevant information to help inform their decision-making about the transfer
    • the person’s preferences about transfer and treatment, including those expressed in an Advance Care Directive or other advance care planning documents, should be respected
    • the person has the right to refuse transfer and treatment, even if needed to keep them alive.
  • Unintended and unnecessary transfers should be minimised for people in the palliative phase.
  • Transfers have better outcomes if they are underpinned by effective planning, risk assessment, coordination, and communication with the person, their family (if the person consents), the person’s substitute decision-maker (if the person does not have capacity), and between care settings.
  • Continuity of care between care settings is a priority. This requires current and comprehensive information about the person’s preferences and needs to be shared with those involved in the person’s transfer and subsequent care.

Page updated 06 February 2024