Case study
CALD Older People Resource
eCALD Supplementary Resources
Advanced directive: GP and residential age care case
Mr Yu is a 90 year old Chinese man admitted to a Residential Aged Care (RAC) facility for respite care under the care of his own GP.
He rapidly deteriorates post admission. The residential care staff call Mr Yu’s GP to come and assess the client. The GP is on holiday and the locum advises that (1) he would prefer not to make a visit to the patient and (2) he does not know the patient, Mr Yu.
Staff are worried about Mr Yu’s medical condition and asked the RAC-contracted GP to review the patient. The RAC-GP does so and advises that the client has an acute lobar pneumonia and on the basis of the local Community Acquired Pneumonia Pathway, the patient needs admission to hospital for intravenous antibiotics. Mr Yu is seriously unwell with marked shortness of breath and a high risk of dying.
Mr Yu does not speak English and there is no Enduring Power of Attorney. His son who is the next of kin and the first contact for the client is available and interprets the RAC-GPs findings and recommendations. Mr Yu clearly declines admission and his son tells staff that this is consistent with his father’s wishes. Further, he explains that his father understands the severity of his illness and the likely outcome. The RAC-GP feels confident with the patient’s direction based on the interactions between father and son, the clarity of the patient’s speech. Mr Yu’s repeated English insistence “no hospital”, and the son’s acknowledgement of his father’s understanding.
The RAC-GP agrees with Mr Yu’s decision and communicates this to him. Mr Yu thanks the RAC-GP. The RAC-GP spends time with the son explaining the likely outcomes and gets his agreement to this process.
The father deteriorates as expected; the RAC-GP reviews the case the next day but now the son is not available and two new family members are present. They are less in agreement with this process. Discussion occurs but they are clearly not as convinced as to the outcomes of the discussion with the son the previous day. Mr Yu has now deteriorated to the point that his wishes are not able to be expressed clearly and his mental capacity would make any directive invalid. The two new family members want Mr Yu to be transferred to hospital.