Angelo* lives alone in a dilapidated house. There is no running water or electricity, no phone, no toilet and the shower does not work. He lives with a mild to moderate cognitive impairment and diabetes. The Royal District Nursing Service visits Angelo each day to monitor his blood sugar levels and administer his insulin. He is attended to on his front porch because his house is considered unsafe for nursing staff to enter.

Angelo was brought into hospital with severe abdominal pain. After an investigation, he was diagnosed with terminal pancreatic cancer and the treating team recommended that Angelo be placed into care. Angelo indicated a strong wish to die at home.

OPA was appointed by VCAT to determine the question of where Angelo should live and the guardian determined that Angelo should go home.

As required by legislation, the guardian made this decision after considering the expressed wishes of Angelo and weighing up what was in Angelo’s best interests. Often these two principles exist in tension with each other. In Angelo’s case, he was very clear about what he wanted. He had lived his unusual lifestyle for many years and had chosen it when he had capacity to do so.

There were clear risks in Angelo returning home but they were mostly in regard to the state of his house and not his treatment. As his cancer was advanced, he was not offered medical treatment. His diabetes had been managed adequately before the cancer diagnosis and Angelo was prepared to accept some modifications to his house.

Several weeks of extensive consultation with the treating team, care providers and Angelo himself occurred to put a range of services (such case management and pain management) in place. An industrial clean of his house was undertaken and a benevolent plumber connected both water and a toilet. Angelo was discharged home.

At some time in the future, Angelo’s need for services may be greater than can be delivered in his home. For now Angelo is able to remain in his own home and maintain his own lifestyle to the maximum extent possible.

*Names have been changed. Image for illustrative purposes only.