2nd Annual Elder Law for the Health Sector

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2nd Annual Elder Law for the Health Sector

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About

As our population ages, pressure is mounting on the aged care and hospital sectors to continue to meet Goal 2 of the NZ Positive Ageing Strategy. To do so is not just a question of more funding or resources, but also of protecting the vulnerable older persons’ rights and dignity as they increasingly come to rely on health professionals, lawyers and next-of-kin.

At this conference, we bring together experts from across the aged care sector – clinicians, geriatricians, gerontology nurses, portfolio managers, palliative care managers, academics, associations, lawyers, auditors, regulators, and many moreto discuss the legal, ethical and practical challenges faced on a daily basis by people working in the sector. The aim is to provide a clearer understanding of where the legal and ethical boundaries are and what happens if they are crossed.

With input from 5 DHBs, we also take a close look at how the health sector is working to implement geriatric practices across departments and to facilitate access to aged care services for the elderly as they transition between health providers.

Keynote by Rae Lamb, Deputy Health & Disability Commissioner, Complaints Resolution

Join us to access the latest updates and thinking on the many legal and ethical challenges posed by aged care provision
• Rights of the Elderly and Ethics of Care
• Capacity Assessment
• Advance Directives and EPAs
• Informed Consent in Aged Care
• Recognising the Clinician’s Role in Improvement of Aged Care
• Protecting the Elderly Patient in the Emergency Department
• Adverse Event Reporting and Open Disclosure
• Audit Requirements for Aged Residential Care
• Findings from the OPAL Survey
• Ageing in Place and the Role of DHBs
• Improving Access to End-of-Life Care
• Legal Boundaries when Faced with Elder Abuse & Neglect

Auckland DHB, Bay of Plenty DHB, Waitemata DHB, Hutt Valley DHB, Wairarapa DHB, University of Auckland, University of Otago, Buddle Findlay, NZ Nurses Organisation, Age Concern NZ, West Auckland Hospice, Health Audit NZ, and Communio.

Also featuring a Gerontology Nurses Panel: Clinical Decision-Making at the Coalface

2 for 1

Only $995 per person with our special 2 FOR 1 DEAL

Register two people from your organisation at the same time to qualify

Agenda

Day 1

8.30

Registration & Coffee

9.00

Opening Remarks from the Chair

Dr Keeling is also President of the Canterbury branch of the New Zealand Association of Gerontology and until December 2009, Director of the NZ Institute for Research on Ageing.

Dr Sally Keeling, Senior Lecturer, UNIVERSITY OF OTAGO - CHRISTCHURCH

9.05

Rights of the Elderly and Ethics of Care

Ethical issues are central to any discussion or reflection on ageing and health care. The ageing population, advances in medicine, and increasing complexity of care means a greater likelihood that health professionals will face ethical problems.
• Ensuring informed consent
• Determining capacity
• Ensuring confidentiality
• Withdrawing or withholding life-sustaining treatment
• Continuing futile treatment

Dr Grant Gillett, Professor of Medical Ethics, UNIVERSITY OF OTAGO

9.50

Capacity Assessment – Examining the Medical, Ethical, Social and Legal Dimensions

In this session, we look at both the medical and legal consequences of capacity assessment.
• What guides the assessment of older people?
• How the outcome of capacity assessment can impact an older person’s right to autonomy
• Do we always end up with the “least restrictive intervention”
• What are the respective roles of the health professional and the lawyer?
• Ethical considerations when planning assessment procedures
• How to overcome cultural challenges and language barriers?

Alison Douglass, Barrister, Waterfront Chambers
Greg Young, Consultant Psychiatrist and Psychogenatrician, Hawkes Bay DHB

10.35

Morning tea

10.50

Providing Services when the Patient is no Longer Competent to Consent – Right 7(4), Enduring Powers of Attorney and Advance Directives

This session will examine the basis on which services can be provided to an elderly patient who is no longer competent to consent to the provision of those services. In particular, it will look at:
• Right 7(4) of the Code of Health and Disability Services Consumers’ Rights
• Changes to the law on Enduring Powers of Attorney
• Applying to the Court for a personal order, or the appointment of a welfare guardian
• A closer look at Advance Directives/Living Wills
• Clarifying the confusion about Do Not Resuscitate Orders

Iris Reuvecamp, Senior Associate, BUDDLE FINDLAY

11.40

Applying the Principles of Informed Consent in Aged Care

• What does informed consent mean in practice?
• What is material to the older person in giving consent
• Levels of involvement of the older person in the consent process
• What constitutes “all reasonable steps”?
• The impact on the consent process of power imbalance between the older person and the health practitioner
• What happens in aged care when informed consent is absent or inadequate

Louise Collins, National Coordinator Elder Abuse and Neglect Prevention Services, AGE CONCERN

12.25

Acute Admissions: How Can We Protect the Rights of the Elderly Patient in the Emergency Department?

In acute care, quick decisions are often required, so when treating elderly patients with limited mental capacity, doctors have to act on the basis of a legal justification for treating in the absence of informed consent. With an increasing number of older people ending up in the emergency departments, how can we ensure the right decisions are made in what is a highly stressful environment for the elderly patient?

Anne Hishon, Team Leader Health in Ageing Community Response Team, BAY OF PLENTY DHB
Tony Lawson, Gerontology Nurse Specialist TPH
BAY OF PLENTY DHB

1.10

Lunch

2.00

Gerontology Nurses Panel: Decision-Making, Ethics and Day-to-Day Challenges

Following on from the morning’s presentations on ethical and legal challenges in aged care, we have assembled a panel of nurses to discuss how they deal with these on the “coal face”.
• What are the ethical issues that confront nurses working in aged care?
• Dealing with next-of-kin involvement and undue influence: who is my patient?
• What are our rights and obligations to the elderly as caregivers?
• Examples of elder abuse experienced by nurses

Margaret Cain, Professional Nurse Advisor, NZ NURSES ORGANISATION
Tony Lawson, Gerontology Nurse Specialist TPH, BAY OF PLENTY DHB
Tanya Bish, Gerontology Nurse Specialist, WAITEMATA DHB

2.40

Older and Wiser - Learning from Complaints about Aged Care

Public outcry over elder abuse in some NZ rest homes has been accompanied by an increasing number of complaints to HDC about residential aged care over the past year. These cover a myriad of issues such as lack of clinical oversight, inadequate supervision, poorly co-ordinated or substandard care, and professional misconduct. In this session we look at recent case studies from the HDC files and discuss the following questions:
• What are we learning from complaints about aged care?
• How can complaints improve care?
• The responsibilities and challenges in responding to complaints
• “Carrots and sticks” - HDC’s approach to aged care complaints

Rae Lamb, Deputy Health and Disability Commissioner, Complaints Resolution

3.30

Afternoon tea

3.50

Audit Requirements for ARC Providers to Meet H&D Standards?

In this presentation, we will go through some features of audit and certification:
• Types of audits performed on rest home providers
• How the audit team works (observations, interviews and reviews)
• The main features of NZS 8134:2008
• How auditors determine the level of attainment with NZS 8134:2008
• Extending the period of certification
• Introduction of unannounced audits for ARC

Dr Michael Thornber, Managing Director, HEALTH AUDIT (NZ) LTD

4.40

Adverse Event Reporting & Open Disclosure for Aged Care Providers

During 2009/10, the Ministry will work with DHBs and other health providers to finalise the draft National Policy for the Management of Healthcare Incidents. 2010 is also the deadline set by the HDC for all DHBs to have open disclosure policies in place. In this presentation, we examine how close we are to achieving both.
• Changes to adverse event reporting for aged care providers
• How can we use the data to minimise the occurrence of adverse events in aged care?
• Your legal duty to ensure open disclosure when things go wrong
• What open disclosure should include and why it is so important

Melanie MacFarlane, Project Manager, COMMUNIO

5.20

End of Day 1 and Networking Drinks

Day 2

9.00

Welcome Back from the Chair

Dr Sally Keeling, Senior Lecturer, UNIVERSITY OF OTAGO - CHRISTCHURCH

9.05

Recognising the Clinician’s Central Role in the Design, Provision and Improvement of Aged Care

In this opening address, we look at clinical governance, accountability and decision-making in geriatric care. With an increased focus on clinical governance in the health sector, how can we make the most of clinicians’ input to improve the quality of care and clinical standards in aged care, contrasting the differing settings where older people receive care?
• How can we ensure that the right checks and balances in place in aged care?
• How can good clinical governance be measured?
• Who should shoulder the responsibility for lapses in care?

Dr Ngaire Kerse, Professor and General Practitioner Department of General Practice and Primary Health Care, UNIVERSITY OF AUCKLAND

9.55

Changes in Aged Care Residents Characteristics and Dependency Levels – Findings from the OPAL Survey

The purpose of the Older Persons’ Ability Level study was to compare dependency levels of ARC residents over the last 20 years in the Auckland region. The data indicate falling rates of proportion of the total population of older people in aged care facilities, a significant increase in dependency and mean resident age, and decreased length of stay. This research provides invaluable information to guide planning and funding of aged care for the future.

Dr Michal Boyd, Gerontology Nurse Practitioner, WAITEMATA DHB; & Senior Lecturer Freemasons’ Department of Geriatric Medicine, UNIVERSITY OF AUCKLAND

10.45

Morning tea

11.10

Ageing in Place: Role and Responsibility of DHBs and Other Health Providers

• Role and responsibilities of DHBs in helping older people remain in their own homes
• How DHBs are re-examining the services offered to create a better fit between funding and community expectations
• Working with other health providers and NGOs in supporting elderly at home
• How to determine when an older person should no longer live independently – ethical and legal implications

Dr Althea Lord, Geriatrician Older Persons & Rehabilitation Service, HUTT VALLEY DHB

12.00

The Role of Transition Care in an Integrated Continuum of Aged Care

In this presentation, we look at the challenges arising from the transfer of older people between hospitals, aged-care facilities and the community.
• Discharge planning
• How to improve the patient’s experience of transition?
• Legal implications of transitioning
• Reducing the risk of re-admission and practical steps to support older people returning home
• Should funding for transition care be increased? A cost/benefit analysis from the DHB point of view

Joanne Edwards, Portfolio Manager, Planning & Funding

12.50

Lunch

1.40

Legal and Practical Pitfalls for the Elderly when Transitioning into Aged Residential Care

A concern raised by many health professionals in aged care is the lack of understanding by the elderly patients and their families of what moving into residential care will mean in practically, legally and financially.
• Barriers to accessing public healthcare when in ARC
• Means testing for patients in hospitals and ARC
• Identifying service gaps in the delivery of older persons services or at the interface between providers
• Knowing what to do when dealing with an incompetent elderly patient
• The emotional and social implications of entering ARC

Wayne Campbell, Team Leader Community Care Access Centre Older Peoples Health, AUCKLAND DHB

2.30

Workshop: The Right to Die with Dignity: Improving Access to End-of-Life Care (Mini Workshop)

• The different options for palliative care and ensuring the elderly patient gets a choice to die with dignity
• Assessment of palliative care needs in elderly patients; who should be involved?
• Legal and ethical challenges faced by caregivers and whanau in palliative care
• Dealing with different belief systems and cultural norms in an end-of-life setting

Barbara Williams, CEO, WEST AUCKLAND HOSPICE

3.30

Afternoon tea

3.45

Legal Boundaries and Obligations when Faced with Elder Abuse and Neglect

Elder abuse takes many forms, from financial exploitation to physical, sexual and psychological abuse. For families, caregivers, nurses, and other health professionals, knowing how to recognise the warning signs and how to prevent or report abuse is vital. In this session, we will provide practical tips on this plus legal advice on victims’ and carers’ rights, on how cases are prosecuted, how to enforce restraining orders, etc.

Jennie Michel, Coordinator Elder Abuse Prevention & Advocacy Services, AGE CONCERN
Nicolette Bodewes, Associate, Schnauer & Co

4.30

Closing Remarks from the Chair and End of Conference

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