The question nobody asks on a tour
People tour an aged care home looking at the room, the garden, the food, the feel of the lounge. Almost nobody asks what happens at the end — and that is the question that decides how your mother will spend her last days.
Because the most common and most avoidable scene is this one: she deteriorates overnight, nobody on shift feels authorised to act, an ambulance is called, and a 92-year-old dies twelve hours later in an emergency department instead of in her own bed.
That almost never happens because anyone chose it. It happens for want of organisation.
Ask these before you sign
- "Is there a registered nurse on site around the clock, or does this home hold an exemption?" Residential aged care homes are required to have an RN on site at all times, with limited exemptions available to some smaller and rural services. If this home holds one, you need to know what covers the gap.
- "Do you have anticipatory medications charted for residents at end of life?" Pre-prescribed medication for pain, breathlessness and agitation is what allows staff to act at 2am instead of dialling triple zero.
- "Which specialist palliative care service do you work with, and how quickly do they come?" Most homes rely on an outreach service. A home that cannot name it does not have one.
- "How do you record a decision not to transfer to hospital, so ambulance crews see it?" A wish written only in a care plan does not travel with the ambulance.
A home whose answer to all of this is "we call an ambulance" has answered you.
Who decides, in law
The directive — and the trap of state borders
An advance care directive lets a person set out the treatment they do and do not want, and appoint someone to decide for them. It is legally recognised across Australia, but here is what catches families out: the legislation, the name of the document and the form differ in every state and territory.
So if your mother made her directive in Queensland and is moving to Victoria to be near you, do not assume it carries across unchanged. Have it reviewed against the law where she will actually be living, and remake it if necessary. This is one of the most common gaps we see, and it only shows up at the worst possible moment.
If nobody was appointed
Then a statutory hierarchy decides who the substitute decision-maker is — a spouse, then a carer, then close family, with the exact order set by state law. That is where sibling disputes are born, always at the worst time. Appointing someone in writing, while your parent still can, prevents it.
Give the home a copy, give the GP a copy, and confirm it is actually on file. Ask them to show you.
What good care includes
- Palliative care is part of what an aged care home must provide, in line with the quality standards. It is not an optional extra you have to argue for.
- Pain and symptom relief is not a concession. Adequate relief, including palliative sedation where clinically indicated, is part of proper care.
- Voluntary assisted dying is legislated in Australian states and territories, with strict eligibility criteria and a defined process. Each provider decides its own level of participation, and some will not permit any part of it on their premises — which can mean a transfer at the worst time. If this matters to your family, ask before you choose and get the answer in writing, and speak to your state’s care navigator service rather than to the home’s administration.
What to ask for while it is happening
- A case conference with the GP and the clinical manager together, to put the goals of care in writing: hospital or not, antibiotics or not, artificial feeding or not.
- A palliative care referral early, not in the last forty-eight hours. It is requested, it does not arrive by itself.
- Unrestricted visiting and permission to stay overnight. Most homes allow it at end of life — ask explicitly and have it noted.
- That nothing is decided without calling you, if you are the appointed decision-maker. Put it in writing once.
After the death: the agreement does not stop that day
Nobody thinks about it, and then the account arrives. Ask now, before signing, how fees are handled after a resident dies, how long the family has to clear the room, and — if a refundable accommodation deposit was paid — how and when it is refunded. The refund is subject to a legislated timeframe once the required documents are provided, and knowing that in advance saves a distressing argument later.
Ask too what the home’s practice is in the hours immediately after a death: whether family can stay in the room, and for how long. It varies a great deal, and knowing beforehand means not having to negotiate it on the day.
The practical point
Make the directive under the law of the state she will live in, appoint a decision-maker in writing and check the home has it on file. On the tour, ask about the 24/7 registered nurse, anticipatory medications and the palliative outreach service by name. And get the goals of care written down before the crisis — that is what prevents the ambulance trip nobody wanted.
If you are still comparing homes, Curalune Care Help gives you the starting point: 3 to 5 suitable homes matched to the real situation within 24 working hours, with contact details, links and a ready-to-send message to all of them at once. A$109, one-off. Start here
Advance care directive legislation, the name and form of the document, substitute decision-maker hierarchies and voluntary assisted dying laws differ by state and territory and are revised regularly; staffing requirements, exemptions, fee arrangements after a death and refund timeframes are set by Australian Government aged care legislation and by each resident agreement. Speak to the GP, a specialist palliative care service and, where relevant, your state’s care navigator service, and get commitments in writing. This article is general information and is not legal or medical advice. Curalune does not allocate places and does not guarantee availability.