Advance Care Directive for Aged Care and Nursing Homes in Tasmania

Why Aged Care Admission Is the Critical Trigger

Moving into residential aged care is the point where advance care planning stops being theoretical and becomes operationally urgent. Once you are living in a nursing home or aged care facility in Tasmania, your daily care decisions are made within an institutional framework — and the staff managing that framework need clear, accessible documentation of your medical wishes.

Yet this is also the stage where ACD creation becomes harder. The people you might naturally ask to witness your directive — the staff who know you, the carers who help you daily — are the exact people Tasmanian law disqualifies from acting as witnesses. And the logistics of arranging two independent witnesses who can visit you at the facility add a layer of friction that many residents and families never overcome.

Witnessing Rules for Facility Residents

If you live in a nursing home, aged care facility, or supported accommodation in Tasmania, the witnessing restrictions hit you harder than anyone:

Disqualified: Any staff member, owner, administrator, or manager of your residential facility. This covers everyone — from the facility CEO to the nurse who changes your bedding, the kitchen staff, the receptionist, and the cleaning crew. The breadth of this disqualification is deliberate; it prevents even the appearance that a facility influenced a resident's medical decisions.

Also disqualified: Paid carers and support workers involved in your daily physical care, close relatives, your Enduring Guardian, and anyone who helped fill out the form.

Practical options: Ask a friend, former colleague, or neighbour who is not related to you and does not work at the facility. A Justice of the Peace can serve as a witness. Your solicitor can witness but also charge for their time. Religious ministers or chaplains who are not employed by the facility may also qualify.

Some aged care facilities in Tasmania will help coordinate witnessing by arranging for visiting community members or volunteer JPs to attend the facility on designated days. Ask your facility's care coordinator whether this service is available.

Making the ACD Before or During Aged Care Admission

Before Admission

The ideal timing is before you move into the facility. At this stage, arranging witnesses is simpler, you have more control over the logistics, and there is no question about institutional influence.

If you are helping a parent or family member plan for aged care admission, put the ACD at the top of the pre-admission checklist — alongside the financial assessment, Centrelink accommodation supplement forms, and the refundable accommodation deposit negotiation. The directive should be completed, witnessed, and ideally registered with TASCAT before the move.

After Admission

Making an ACD after you are already in a facility is more challenging but absolutely possible. The legal requirements are the same — you must have decision-making capacity, use the approved THS form, and have two independent adult witnesses.

The key challenge is logistics:

1. Find two eligible witnesses. Neither can be a facility employee or a relative. Ask family members to bring friends, contact a local JP service, or ask your GP if they can attend with a nurse from their practice (provided the nurse is not also employed by your facility).

2. Confirm capacity. If there is any question about your cognitive state, ask your GP or the facility's visiting medical officer to conduct a formal capacity assessment on the same day. The written assessment note, stored alongside the ACD, protects the directive against future challenges.

3. Sign at the facility. There is no requirement to leave the facility to make an ACD. The signing can take place in your room, a common area, or wherever is comfortable — as long as both witnesses are physically present.

Integrating Your ACD Into the Facility's Care Plan

Once your ACD is made, the facility needs a copy integrated into your care plan. This is not automatic — you or your Enduring Guardian must actively provide it.

Give a copy to:

• The facility's care coordinator or director of nursing. Ask them to record the ACD in your clinical notes and set a flag so any staff member reviewing your file sees it immediately.
• The visiting GP or medical officer. Your facility-based doctor should have the directive in their patient file, particularly if they will be the one translating your ACD into a Goals of Care plan when clinical decisions arise.

Ask for confirmation. Request written confirmation from the facility that your ACD has been received and recorded. Some facilities use intake checklists that include advance care planning — make sure the ACD is ticked off and not left in a "to be completed" pile.

What Happens When You Are Transferred to Hospital

Aged care residents are frequently transferred to hospital — for falls, infections, acute cardiac events, or scheduled procedures. This is the moment your ACD needs to travel with you.

In practice, the hospital admitting team should:

1. Check your facility transfer notes for any recorded ACD or GOC plan
2. Check your My Health Record for an uploaded directive
3. Contact TASCAT to verify whether a registered ACD exists (if time permits)
4. Ask your Enduring Guardian about your documented wishes

The reality is that emergency transfers are chaotic. Ambulance crews arrive, clinical handover notes may be incomplete, and your ACD copy sitting in the facility's filing system may not make it into the ambulance.

To mitigate this:

• Upload your ACD to My Health Record — this is accessible to any hospital in Australia and does not depend on physical paperwork travelling with you
• Give your Enduring Guardian a copy — they can present it to the hospital admitting team and advocate for your wishes in person
• Register with TASCAT — a registered directive can be verified by the hospital even if no physical copy is available
• Ask the facility to include ACD details on transfer forms — some Tasmanian facilities now include advance care planning status on their standard hospital transfer documentation

The Aged Care Quality Standards Connection

Under the Aged Care Quality Standards (Standard 2: Ongoing Assessment and Planning), approved providers are expected to support residents in documenting their advance care preferences. If your facility is not proactively discussing advance care planning with you or your family, raise it — and consider making a formal request that the conversation be recorded in your care notes.

This also matters for family members advocating on behalf of a resident who can no longer participate in the planning process. If your parent or relative did not make an ACD before losing capacity, the facility should still be working with the Enduring Guardian (if one was appointed) and the family to document values and preferences that inform clinical decision-making — even though these cannot carry the legal force of a statutory ACD.

Getting Everything in Place

The Tasmania Advance Directive & Living Will Kit covers the complete aged care planning scenario — from pre-admission ACD preparation and witness verification sheets through to the TASCAT registration process, My Health Record upload steps, and a facility integration checklist that ensures your directive is recorded in all the right places before the emergency happens.

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