Aged care residents are being transported to hospitals to undergo voluntary assisted dying, while doctors conduct assessments in carparks after being barred from nursing homes.
In the past year, renal and general physician Margaret Fraenkel has treated two Melbourne patients who have been blocked from accessing voluntary assisted dying (VAD) in their aged care homes.
One made plans to transfer to hospital to access the scheme, while the other tried to transfer to another aged care home. They both died before they could receive the medication.
“They are already stressed about the VAD and their looming death,” said Fraenkel, who works across public and private hospitals.
“Then they’re shipped out to meet their death in unfamiliar surroundings.”
Fraenkel said services were failing to meet their obligations under federal aged care standards, which state older people have the right to choose to access VAD in their home, “including where their home is a residential care facility”.
The situation coincides with a new report by Go Gentle Australia, which reveals that many Australian aged care providers are failing to support their residents’ end-of-life choices, with 66 per cent providing no public information about assisted dying, despite it being legal in every state.
Within days of moving into an aged care facility in Melbourne last June, Rosemarie Germano said she wanted to undergo voluntary assisted dying.
But the 82-year-old, who had terminal cancer, hit a wall.
“They just said that management doesn’t support VAD,” her daughter Susie recalled. “They gave no reasoning and didn’t suggest contacting anyone else for help.”
As well as not allowing assisted dying on site, the aged care home would not even allow a doctor to conduct an assessment of Rosemarie on its premises.
“It was a complete shock,” Susie said. “Not once was it mentioned to us that they don’t support VAD. They knew Mum was terminal when she entered.”
Susie felt her only option was to transfer her mother back to the Epworth Hospital, where she had previously received treatment for brain tumours that had metastasised from her kidney.
The oncology team at the Epworth arranged for Rosemarie to be transported back to the health service to be assessed.
She spent the next three weeks in a hospital bed waiting for her application to be approved, before receiving her medication.
“It was so incredibly distressing,” Susie said. “She did not want to live any more. Everything had been taken from her so quickly. She felt like she had no control … her agency was taken away.”
Susie is advocating for aged care facilities to disclose their stance on voluntary assisted dying to prospective residents, just like they do with fees and meal plans.
Oncologist Cameron McLaren has had to assess patients for voluntary assisted dying in the car parks of Victorian aged care homes because staff have not allowed him on site.
“That’s not the way this should be conducted,” he said. “This is a valid medical consultation. It shouldn’t be cloak and dagger.”
He’s also been involved in cases where residents have had to transfer to hospital because their aged care home has refused to allow voluntary assisted dying on site.
“Everyone is told that this is now your home … and when they are told they can’t do something in their home they feel misled.”
Go Gentle Australia chief executive Linda Swan said aged care providers were withholding information about their stance on voluntary assisted dying, leaving residents and their families in the dark.
“You need to let people know what services will be available in your facilities,” she said.
The organisation has rated 70 of the largest providers of aged care in Australia and published the findings in a new report and a searchable online database.
Of the 12 large providers rated in Victoria, just one aged care service, Regis, received a green tick of approval.
It’s the only service that has published information on its website about voluntary assisted dying, which it states is available to any resident who requests it, as long as it’s in line with legislation. “Members of our team can be approached to provide support and assistance through this process,” it reads.
While many providers said they did not impede access to voluntary assisted dying, they received a poor rating because they had not published their stance.
In South Australia, Queensland and New South Wales, aged care providers are required by law to inform the public if voluntary assisted dying is not available in their facilities, however there is no such requirement in Victoria.
A total of 389 assisted deaths were recorded in Victoria last financial year, compared with 1028 in NSW, 1072 in Queensland and 480 in Western Australia.
Craig Bardrick, the chief executive officer of BASS Care, said his aged care service supported voluntary assisted dying and had provided support to a number of residents since the scheme came into effect in 2019.
“We provide information to residents on request as we believe that it is a personal choice,” he said, when asked why the information wasn’t made public.
Other aged care providers contacted by this masthead said they supported residents’ rights to access voluntary assisted dying, but had not published this information because they were fearful of falling foul of the state’s gag clause, which prevents health practitioners from raising the subject with their patients.
Swan said this was a misconception, and the gag clause did not prevent aged care homes from publishing this information.
A Victorian government spokeswoman said all aged care providers were expected to consider voluntary assisted dying as part of their end-of-life framework and to make their policy available to prospective and current residents.
“We expect aged care providers to be responsive and forthcoming with requests for information regarding VAD,” she said.
“Because some Victorians have faced challenges in accessing VAD, we have passed reforms that will make our laws fairer.”
This includes removing the gag clause, which will come into effect from April 2027.
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