Advance Directive for Aged Care in Queensland: What to Have in Place Before Moving In

Why Aged Care Admission Is the Critical Trigger

The transition into residential aged care is the single most common moment when advance care planning documents are requested — and the moment when families discover they don't have them. Most Queensland aged care facilities ask for copies of an Advance Health Directive and Enduring Power of Attorney during the admission process. Some facilities won't proceed without them, or will flag their absence as a risk in the resident's care plan.

The practical reason is straightforward: residential care facilities regularly face medical decisions on behalf of residents who can no longer communicate their preferences. A fall that causes a hip fracture, an infection that requires hospitalisation, a decline in swallowing ability that raises the question of tube feeding — these situations arise routinely, and the facility needs to know who has authority to make decisions and what the resident's preferences are.

The Documents Queensland Aged Care Facilities Expect

Advance Health Directive (Form 4)

The legally binding document under the Powers of Attorney Act 1998 that records the resident's treatment preferences — what medical treatments they consent to, refuse, or want provided only in specific circumstances. Facilities file this in the resident's clinical record and reference it when treatment decisions arise.

Enduring Power of Attorney (Form 2 or Form 3)

The document that appoints someone to make decisions on the resident's behalf. For aged care, both financial and personal/health powers matter:

• Financial powers are needed to manage the resident's Refundable Accommodation Deposit (RAD), ongoing care fees, and any property transactions (such as selling the family home to fund the RAD)
• Personal and health powers authorise the attorney to consent to medical treatment, make decisions about the resident's daily care, and liaise with facility staff

Statement of Choices (Form A or Form B)

While not legally binding, the Statement of Choices is the document Queensland Health and many aged care providers use for values-based care planning. It records the resident's preferences about quality of life, comfort measures, spiritual and cultural needs, and who should be involved in decisions.

Many aged care facilities complete a Statement of Choices as part of their admission process, even if the resident already has an AHD. The two documents serve different functions: the AHD gives legally binding clinical directions, while the Statement of Choices gives the care team broader context about the person's values and priorities.

The Capacity Window

Here's the problem families encounter: by the time someone moves into residential care, their cognitive capacity may already be in question. If a parent has moderate-to-advanced dementia, they likely can't execute a valid AHD (which requires a doctor's capacity certificate confirming they understand what they're signing) or a valid EPOA (which requires the principal to understand the nature and effect of the document).

Once capacity is lost, the options narrow:

• The statutory health attorney hierarchy applies for health decisions — spouse first, then adult children, then parents, then siblings
• For financial decisions, the family must apply to QCAT for an administration order, which involves hearings, delays, and potential appointment of the Public Trustee
• The resident has no legally binding treatment preferences beyond what the statutory health attorney decides in the moment

The window to execute these documents is before or during the early stages of cognitive decline. A person with mild cognitive impairment or early-stage dementia may still have sufficient capacity to execute an AHD and EPOA — but the capacity assessment becomes more critical, and the doctor completing Section 5 of the AHD needs to be thorough in documenting that capacity exists at the time of signing.

What to Prepare Before the Admission Meeting

Aged care admission meetings move quickly, and the facility's administrative team will ask about advance care planning documents alongside financial and lifestyle questions. Coming prepared avoids follow-up requests and ensures the resident's preferences are in the clinical record from day one.

Bring copies of:

• The completed, signed, and witnessed AHD (Form 4)
• The completed, signed, and witnessed EPOA (Form 2 or Form 3)
• Any existing Statement of Choices
• The attorney's contact details (phone, email, address)
• The GP's contact details and any recent medical reports

Confirm:

• That the AHD has been uploaded to Queensland Health's The Viewer via the Statewide Office of Advance Care Planning (so hospital emergency departments can access it if the resident is transferred)
• That the EPOA is registered with Titles Queensland if property transactions are anticipated
• That the named attorney understands their role and is prepared to be the facility's primary contact for clinical decisions

Reviewing Documents After Admission

Advance care planning isn't a one-time event. A resident's preferences may shift as their health changes — someone who entered care relatively independently may develop new conditions that change their treatment priorities. Most facilities conduct annual care plan reviews, and this is a natural point to revisit the AHD and Statement of Choices.

If the resident still has capacity, they can update their AHD by revoking the existing one and executing a new version. If they've lost capacity, the existing AHD stands as-is, and the appointed attorney makes decisions within its framework.

The Queensland Advance Directive & Living Will Kit includes a pre-admission checklist, a document distribution tracker, and clinical phrasing templates specifically designed for the aged care context — covering common scenarios like hospital transfer decisions, feeding and hydration preferences, and resuscitation instructions.

See more Queensland guides →