Navigating VAD with wisdom and kindness – Uniting NSW.ACT’s Tracey Burton shares the policy and heart behind supporting residents, front-line staff in this deeply human area of care

Being an important and oftentimes dividing area of care, Voluntary Assisted Dying (VAD) has regularly found itself in the headlines. It is a topic that has rightfully seen much rigorous debate in government and for provider leadership it is an area that has required substantial delicacy and deliberation. Importantly, in talking to Tracey Burton of NSW.ACT the discussion is taken from the “out there” to walking closely alongside individual seniors, their loved ones and front-line staff that make up their community. The story Burton shares is of a provider putting the next best foot forward in an area that is complicated, that requires the contribution of skills not necessarily taught in textbooks. Placing wisdom and kindness, first and foremost, for the seniors navigating the option of VAD, as well as the front-line staff who hold cherished relationships with residents, showcases thoughtful leadership. It is also in shaping policy and procedures to safeguard those who have differing views on VAD that Burton highlights a provider can use policy to protect all. Burton shows that in this area of complexity, putting compassion, communication and kindness upfront, leadership may shape a journey where no one ever feels alone.

Any care must be individual and personal

In navigating the discussion well, Burton highlights the rarity of those who seek to pursue VAD. Any care, whether in the routine of palliative care or navigating VAD must be underpinned by communication, compassion and excellence in care.

“Voluntary assisted dying is such a rare event in the aged care setting, and it’s incredibly personal – different for every individual.”

She notes that while VAD is an important topic for provider leadership to navigate, active palliative care must remain shaped and supported to provide the highest quality end of life care, “the vast majority of residents pass away with active palliative care supporting them and their loved ones – equally personal and needing to support individual preferences.”

Regardless of approach, Burton recognises that, “clear communication and compassion is so vital.”

“Symptom management is a clinical aspect of palliative care, directed and overseen by medically-trained staff. [As well] Psychosocial care is administered by our trained aged care staff, people with established relationships with the resident and their families and spiritual care is the purview of our chaplains.”

The whole community

Burton shares that as a provider, while now a legal obligation, the opportunity for significant deliberation among the leadership team is still critical. Deepening the decisions and hopes for how to meet the law of VAD and how that will look like for all, in the routine and daily, is an important opportunity for leadership.

“Under the law in all Australian jurisdictions now – other than the Northern Territory – people with terminal illness have the right to choose Voluntary Assisted Dying and as one of the country’s biggest aged care providers Uniting has given considerable thought to how we support our communities”, she says.

“We need to consider differing views among staff, other residents, and family, in addition to the person choosing Voluntary Assisted Dying.”

Burton shares, “aged care residences are irrefutably peoples’ homes but they are also communities, with all the love and relationships that typify communities. Deep relationships, long serving staff, long-time residents, vulnerable residents and a huge array of personal beliefs.”

“So our approach to Voluntary assisted dying gives consideration to the whole community including the perspectives of staff, families, and other residents in addition to the resident choosing VAD.”

In seeking to invest in policy and approach that leaves no member of the community isolated, Burton notes a policy decision, “our care includes attention to communications, including debriefing and access to EAP and our chaplaincy network.”

Peaceful and dignified

Any discussion on VAD is hollow without elevating the story of the seniors and loved ones who have navigated this care option.

While Burton shares that, “Uniting NSW.ACT is committed to delivering person-centred care to all residents, including those who elect to access Voluntary Assisted Dying”, she seeks to ground this messaging in the reality of Uniting walking alongside a senior and their loved ones through VAD.

“To give an example, the family of a resident who chose VAD at one of our homes this year expressed deep gratitude for the compassionate support provided by staff, describing the experience as peaceful and dignified.”

She shares, “The resident’s extended family visited the home for a final farewell and returned on the day our resident had chosen as the day of his passing.”

“In preparation, staff were thoroughly briefed by the VAD Care Navigator team regarding what to expect and were offered opportunities to debrief afterwards. These experts who come in from the Local Health District are critical at every stage of VAD.”

Burton highlights policy and rostering decisions that underpinned the enactment of “person-centred care” in reality, “additional staff were rostered to ensure the resident received dedicated care throughout the day.”

“To assist the family and staff the home arranged catering and made chaplaincy and pastoral care services available for emotional and spiritual support.”

Burton notes that there is always a place for dedicated staff members within providers who have a huge heart for caring but may have differing views on supporting, in theory and practice, VAD, “staff members who chose not to participate were respectfully assigned to other areas.” 

Policy supporting calm

The thoughts and discussion Uniting’s leadership team entered into surrounding VAD was to seek to translate wisdom and kindness into the embodiment of policy and practice in VAD delivery. Handling this weighty area of care, not only to safeguard those who sought to opt into the program, and their families, but also support front-line staff who would and wouldn’t be present.

Wisdom and kindness are central to supporting not only those opting in but to ensure that no one is vilified for having a heart-felt conviction otherwise.

Burton shares that as a result of the policies enacted, the resident, family members and staff present were able to be calm, “These measures contributed to a serene and supportive environment for the resident’s final moments.”

“It was calm, beautiful and respectful death and his family was grateful.”

Collaborative learning

Burton is helpfully transparent in sharing the state of growth and change that Uniting and all roles of staff have gone through in the delivery of VAD.

“That home has developed learnings by reflecting on the experience of people choosing VAD and these have since been shared across other Uniting residential aged care sites.”

In the area of life and death, understanding that wisdom may evolve, that policy can be updated, that approaches can be shifted is deeply human, warranted and worthwhile. Burton indicates that leadership can always be ready to, in humility and openness, learn from experiences, listen to residents, families and staff, and be ready to shift.

In the significant differences of background and faith-convictions that staff bring, Burton highlights the wisdom and strength of humility and communication to direct policy change, “Uniting has learned it is very important to prepare staff well, particularly given the diversity of religious and cultural beliefs among team members.”

Policy shift

Burton indicates that these instances of learning are never filed away, or given lip-service acknowledgement. Sharing specific points of adaption and iteration from VAD delivery, Uniting leadership have continued to allocate resources to grounding what it is to provide “person-centred” care.

“There have been 16 instances of VAD across Uniting’s 70 services in the two years since the legislation was introduced in NSW”, she shares.

“Each experience has deepened our understanding of VAD and led to improved preparations to support residents and their loved ones.”

·        “Family involvement and transparent communication were consistently valued, contributing to more compassionate and supported processes.” 

·        “Staff education, emotional preparation, and structured debriefing significantly improved team wellbeing, especially when implemented proactively.” 

·        “Conversely, limited notice, unclear responsibilities, and minimal external support could be distressing.” 

·        “The importance of clear protocols, defined roles, and collaborative planning was evident, particularly in complex scenarios. Respecting resident autonomy while ensuring staff and family support, is central to delivering safe, ethical, and person-centred VAD care.”

Collaboration and transparency for best care

Burton acknowledges the difference that is found in faith-based communities, and centers the provider’s response under the law, “we respect other religious denominations and their discernment on matters as sensitive as VAD. Our role as an aged care provider is simply to respect each individuals’ rights under the legislation.”

In understanding what a RAC facility is at its heart, Burton sees this as powerfully shaping process and obligation.

“Residential aged care is a person’s home and older people have the same rights as rest of the community. We don’t prevent residents from accessing what is their right to access under the law. When viewed like this it is quite simple.”

Burton highlights the leveraging of experts outside of the home in the support of VAD delivery, “the process is managed by the VAD Care Navigators from the Local Health District who are the experts at each stage of VAD, for a resident and their loved ones.” It is in collaboration that providers can navigate delivering VAD to their best ability. No person or provider need be alone in this significant area of care.

An area of policy that has been implemented to safeguard that no staff member feels alienated is clear policy regarding rostering and debriefing.

“Uniting always supports all staff in freedom of choice in regard to VAD including being rostered to a different area if they want this, staff can access our chaplains too – this is one of the beauties of being a faith-based provider.”

Burton highlights the benefit to both provider culture, resident dignity and staff support through a commitment of leadership, at all levels, walking this journey in transparency and accessibility.

“We have found through experience that openness and transparency about what is occurring as much as possible in accordance with the resident’s wishes is important, and comprehensive debriefing after the event is also very beneficial to the aged care home community.”

Person-centred care in the routine

Through all the discussion and management, Burton asserts that in the routine experts in this area of care must be able to do their jobs, “it is essential VAD Care Navigators clearly communicate that VAD is a legal end-of-life option for residents.”

She shares that providers have the opportunity to uphold conscientious difference in tactful policy, “at the same time, staff must be supported if they choose not to be present.”

Yet at the core, she turns it back to the central component at VAD’s heart, a human-being navigating a weighty topic, likely managing other symptoms and challenges as well. For many, choice is a powerful gift within these circumstances.

“We also recognise VAD occurs at the date and time chosen by the resident, not the residential aged care home.”

“On the day, it is all-consuming but it’s the last thing you’ll ever do for that person. The support we offer to a resident reflects their rights and their dignity, because it is their choice.”

“We feel strongly that people should have the right to make their own decision.”