Personal Preferences - Transfers - Managing Risk

Personal Preferences

Decisions about transfers should involve and respect the person’s preferences .

  • The person is left out of decision-making about transfer, or they are transferred to a different care setting contrary to their wishes.
  • Where the person lacks capacity, the person’s substitute decision-maker is not involved in the decision to transfer.
  • The person is not given necessary information in a way they understand to help inform their decision about transfer.
  • The person’s preferences relating to transfer are not respected.
  • Ensure the person (or their substitute decision-maker) is provided with relevant information prior to making decisions about transfer options.
  • Ensure the person’s Advance Care Directive and other care planning documents are:
    - up-to-date and reflect the needs and preferences of the person
    - available to care staff and inform delivery of care including decisions to transfer.
  • Check with the person (and others involved in decision-making relating to their care) that they have the information they need to make decisions, and that they feel heard.

The person is central to decisions about transfers 

The person is central to decision-making. They must be involved in all decisions about their care and treatment, including decisions and planning relating to transfers between care settings.

Their consent (or, if the person lacks decision-making capacity, the consent of their substitute decision-maker) is required before a transfer can occur (noting exceptions may exist in emergency situations – these are discussed further below).

The person will have preferences about transfer, receiving treatment and prolonging their life, which may come from their cultural or faith traditions, or their personal beliefs and values. Where they refuse to be transferred and/or receive treatment, this needs to be respected – it enables the person to have dignity of risk.

Supporting people to die in residential aged care

People nearing end of life may prefer to die within the residential aged care facility (their home), rather than being transferred to hospital for acute care or potentially life-saving treatment. People have a right to die at the facility – this is their home, and it is likely more comfortable and familiar than a hospital environment. Care staff are well placed to understand the person’s needs, preferences, and how best to make them comfortable, and to support family involvement if the person wishes. Aged care facilities need to provide a suitable environment for end of life care.

Learn more about Imprest Medication Systems: Southern Metropolitan Region Palliative Care Consortium – Imprest Medication Systems for RACFs.

The person has a right to refuse transfer

Dignity of risk is a person’s right to make their own decisions about their care and services, including making choices that involve some risks.

A person may decide they do not want to be transferred to receive care or treatment. This is their right and it should be respected. 

Transfers and treatment provided against the wishes of a person may result in unwanted or non-beneficial treatment, and can cause distress to the person, their family and friends and health professionals.

Relevant information is needed to inform decisions about transfers

When engaging with a person (and/or their family, friends or substitute decision-maker) about a potential transfer, it is critical that relevant information is provided including:

•    the reasons a transfer may be needed
•    where they could be transferred to
•    the risks involved in the transfer
•    benefits of the transfer
•    whether and how the transfer may be avoided (for example, if additional supports can be put in place).

If there is disagreement or ambiguity about whether a transfer should occur, it is important these are discussed and resolved.19

Preferences may be captured in Advance Care Directives and planning 

The Aged Care Quality Standards require providers to undertake ongoing assessment and planning with residents to identify and address their current needs, goals and preferences. This includes advance care planning and end of life planning if the person wishes. 

If the person has expressed preferences about transfer and treatment in an Advance Care Directive or other care planning documents, these should be known and respected. These documents should also be recorded or stored where all staff can access them. 

Respecting the person's preferences

  • Empower the person to make decisions about their transfer and treatment options – including in emergency situations.
  • Involve others the person wants to help support their decision-making (e.g. family and friends).
  • Know of any preferences expressed by the person in their Advance Care Directive and planning documents.
  • If the person lacks capacity, seek consent from the person’s substitute decision-maker.

Others may support decision-making

The person may choose to involve their family, friends and health professionals in discussions about transfer and treatment, to inform and assist their decision-making. They should be kept informed about transfers (so long as the person has consented to this).

There may be a substitute decision-maker

If the person does not have decision-making capacity (their doctor would normally determine this), decisions about and consent to transfer should be sought from the person’s substitute decision-maker.

Special considerations apply in emergency situations

If transfer and treatment is required in an urgent situation e.g. an emergency and the person has capacity, the person’s consent to transfer should be obtained. If a person has capacity and refuses treatment or transfer this should be respected, even if this means their life may be at risk.20 If the person does not have capacity and a substitute decision-maker’s consent cannot be obtained, transfer and treatment can occur if there is an urgent need to save a person’s life, prevent serious damage to health, or prevent significant pain and distress. In South Australia, Western Australia, the Northern Territory, and in some circumstances in Queensland, where a person without capacity needs urgent treatment, health professionals must seek consent from the person’s substitute decision-maker if it is possible to do so. Though not a legal requirement in other jurisdictions, it is still good practice to obtain a substitute decision-maker’s consent if possible. If the person has made an Advance Care Directive refusing transfer or treatment, that refusal should be respected. The law in some States and Territories requires health professionals to make reasonable efforts to try to locate a person’s Advance Care Directive before providing urgent treatment.

Page updated 29 January 2024