Frequently Asked Questions
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What does ExSitu mean?
Both the founders of ExSitu have extensive experience in working with older people and they happen to share a passion for environmental conservation. The name ExSitu stems from this, and literally means “off-site conservation”. It is the process of protecting the important elements of an ecosystem that could become vulnerable.
Do you supply training on how to use your software?
We can even come in and facilitate individual sessions to help your clients.
Or we provide a range of helpful training documents you can follow without training or intervention required for the budget conscious centre.
However, you want to use ExSitu is entirely up to you!
We want to trial ExSitu at one aged care centre before making a full commitment. Is this possible?
We want to train our staff to use the software so they can support the residents. Is this possible?
Our aim is to make ExSitu so easy to use, it makes compliance simple. And that the process of taking your clients and staff through ExSitu empowers people to feel more heard and better able to connect over individual care plans.
Can you help us implement ExSitu?
The choice for most care providers comes down to the time available when supplying support.
Self-directed ExSitu planning is for the client who knows what they want and when they want it. They require little support with technology. And are confident and curious about creating protective documents to enhance the years ahead.
Facilitator supported ExSitu planning is ideal for providing direct assistance and educating large groups on value-based Advance care planning. This can be done online or in person and helps time poor care providers meet compliance needs. All without adding an extra burden on an already full schedule!
Enterprise level training is also available. Our facilitators can provide tailored training and support to begin large-scale roll outs. This is ideal for upskilling your care or nursing team, or mobilising clients to complete the process on scale. POA
How does ExSitu help with compliance?
How user friendly is ExSitu?
ExSitu was designed with real people in mind.
It runs in a simple browser for ease of access. You only need an internet connection and a browser to access ExSitu.
The software helps make decisions via card sorting. What resembles a tarot card spread or game of patience is actually a thoughtful, guided process that captures a person’s values, wishes and ideals.
Adding additional information is as simple as typing under a question.
And the care plans we generate can be used and uploaded as stand alone PDF documents, or integrated with your existing care planning processes and fed into the system your organisation is using.
Does ExSitu work with other record keeping software?
How have you rolled out your approach to values-based care so quickly?
It’s exciting to be on the forefront of a growing movement towards creating person-centred care in the later stages of life creating more robust end-of-life documents as well as capturing the values that help provide the individual care your clients want.
Why are values important to the Advance care process?
We don’t always maintain the ability to advocate for ourselves. But we can give the people who care for us a deeper understanding of what matters to us.
Without understanding a person’s values, it can be more difficult to deal with complex and granular decisions. This was especially true after seeing families impacted by a loved one’s loss of capacity. And the toll the stress of not having an accurate roadmap of patient care can take on a dedicated nursing team.
By understanding a person’s values, we have the opportunity to quantify and qualify what their version of autonomy, choice and support looks like. ExSitu is there to remove the assumptions and encourage people to share what matters to them.
How does ExSitu help balance the needs of an organisation with the preferences of an individual patient/client?
Charting where and when the line is drawn between dignity and risk is part of what ExSitu offers. With ExSitu, your clients can articulate whether it’s worthwhile to risk falling ill while seeing a last rainstorm. Or absolve you of responsibilities with policing someone’s nightly sherry. Or fulfill their desire to exercise over protecting them from a fall.
How long does it take staff to complete?
Who assists people to complete ExSitu (Does it need a Registered Nurse)?
However, for added peace of mind, you can also book training and even facilitation to help frontline staff answer any questions that may arise.
63% of my customers have a reduction in cognitive ability. How will this help?
We’ve also written ExSitu HOV plans to prompt with questions that cater to a reduction in cognitive function, learning difficulties and/varying degrees of English-language competency. That way, language is not a barrier to articulating a person’s values.
Wherever possible, we highly recommend using ExSitu prior to a person needing it. This includes making ExSitu part of an onboarding process into an organisation over talking about care once it becomes a necessity.
Can I just use the HOV as my clients have dementia and or lack capacity?
Yes! You can choose to make of the two care plans together or separately. The choice is yours. Whatever is the most appropriate for the situation at hand.
Capacity isn’t always a yes or no situation. Although a person may not be able to make medical decisions and or financial decisions, They can still enjoy decision making in other areas of their life. ExSitu supports the expression of those values using the principles of supported decision making and a rights-based care approach.
What research did you do to come up with the cards?
The development of ExSitu cards used design thinking methodology in a many layered process
Firstly, we drew on our own experience as aged care professionals. We then worked in challenge-based environments to articulate the issues faced by clinicians and clients alike. This was added to industry research into particular challenges with care provision and end-of-life care.
We tested and retested the questions we had to shortlist via a card sorting process. This card sorting process lends itself remarkably well to developing large-scale software with competing and expansive needs.
What we found was that the same card sorting process we were using to develop our software was also perfect for helping individuals make complex decisions!
After 2 years of beta runs and tests, we launched the ExSitu you know and love in January 2019. Since then, we’ve seen the information collected by ExSitu help everyday Australians receive individualised care, families make supported care decisions, and even been honoured to see the words collected by our clients reflected in their eulogies.
We’re continuing our commitment to providing the best quality care plans through working with Australian care providers to meet and exceed accreditation standards.
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What do you do?
Glad you asked! We offer values-based care plans and Advance care plans that help individual Australians and large organisations navigate the later stages of life more effectively. We’re basically the place you go to make sure that the space between retirement and end-of-life is as unique and as tailored to you as a person as the decades beforehand.
We are your champion for personal preferences through to medical decisions. We help articulate the most granular parts of someone. This in turn makes for truly values-based and person-centred care.
How does it work?
Through a unique card sorting process, ExSitu breaks down some of the most basic and complex questions about who we are. With ExSitu, you’re asked to think about what your goals, values and what matters most to you. You can articulate your wishes and have your ideals recorded. You can choose what level of care you might receive through to what is an acceptable risk in your eyes.
These details, decisions, ideals and values all go into forming plans that help make your legal, social and medical decisions and help carers and centres meeting your needs in the later stages of life make informed decisions.
They also stand in your stead should you ever lose the ability to make decisions for yourself. That way, your loved ones and carers can focus on supporting you and your decisions without guesswork, guilt and added stress.
It’s about making sure you receive the best of care while reducing the stress on your friends, family and carers in the process.
Is my Advance Care Plan recognised by law?
ExSitu Advance care planning documents meet the requirements for Advance Care Planning in Australia under common law. Some States or Territories in Australia have specific Statutory legislation with regard to Advance care directives and plans. You can find more detail at https://www.advancecareplanning.org.au. and https://end-of-life.qut.edu.au/
How did ExSitu come into being?
Two aged care nurses wanted to help ageing Australians have a voice when it came to treatment, choices, care options and end-of-life. By seeing the best – and sometimes the worst – of what can happen to an individual and their family, they wanted to create an easy-to-follow, robust and incredibly individual approach to capturing the essence of a person.
ExSitu’s Advance care plan and Hierarchy of Values is a result of that desire. It puts the person in charge of future person-centred care.
Backed by leaders in both innovation and aged care, ExSitu is empowering Australians to define their ageing and end-of-life experience.
ExSitu’s aim is for Australia to lead the world in the uptake and use of values-based care and advance care plans in the later stages of life. And in doing so, to give every Australian access to the most respectful, individual and positive end-of-life experience possible.
Why is having ExSitu’s care plans important?
Having a recorded hierarchy of what you value means the people caring for you can champion some of your more individual choices. From the things you enjoy day-to-day through to the finer points of bodily autonomy, family relationships and more, our values-based care plans make decisions easier. The ExSitu Hierarchy of Values helps the people who care about and for you navigate complex decisions, add extra special touches to your care, stand up for your wishes and more.
An Advance care plan articulates your care wishes, medical choices, and what is and isn’t suitable risk and reward when it comes to end-of-life decision making. It delves into how much treatment is too much treatment and helps uncover your definition of quality of life. It also champions your medical choices, even if you lose the ability to speak for yourself.
It’s your opportunity to see your needs met right through the later stages of your life to your life’s end. All the while reducing the impact of trauma, grief and applied stress on loved ones, carers and other decision makers in your life.
Can you give me an example of something ExSitu can help me decide?
Yes! Here are a few sample scenarios to get you thinking about the sorts of choices that matter to you.
- If you were receiving chemo for managing stage 4 cancer tumours and your kidneys failed as a result of the chemo, would you want dialysis? Would you want to continue with chemo?
- Would you prefer to see one last belly busting rainstorm and risk worsening a cold or pneumonia? Or would you prefer to miss the storm and stay around for an extra week instead?
- If you lost more than one of your senses, how would you feel?
- Would you prefer to die at home, surrounded by friends and families with your pets by your side? Or would you feel more safe and secure in a hospital or hospice environment?
- Would it be important for you to have access to spiritual support at end-of-life? Would your choices related to spirituality be understood and respected by the people supporting you?
ExSitu can help you define what is and isn’t acceptable risk when it comes to your body and mind. That way, your family and carers always have guidance in the care-based decision-making process.
What happens if I don’t have an Advance care plan in place?
The best way to think about an Advance care plan is as something that protects you when you are at your most vulnerable.
Not having an Advance care plan in place can reduce the chance of you receiving a more individual end-of-life experience. Take medical interventions for example. An aged care facility, hospital or family member may continue medical interventions past where you personally might like. Or it advocates for choices you might make that perhaps other people in your life wouldn’t.
An Advance care plan also reduces the stress for the people making those decisions on your behalf. Think about how stressful it might be for your family and carers if something were to happen to you. Most of us would prefer to leave the people we love with space for grief and comforting each other. Yet the nature of end-of-life often means it is a process of making hard decisions with little or no guidance. People who have little, or no experience of the medical system or disability are asked to make do the best they can. Many sadly experience guilt, self-doubt and feel overwhelmed as a result.
You can’t change that the situation will be difficult and heartbreaking. You can however reduce how many legal, medical and intangible decisions need to be made. When you leave a blueprint of your values and what you might want as treatment, you forearm your loved ones. You give the gift of space for your loved ones and carers to experience their emotions. All while limiting their obligations and stress through helping them understand what decision might be the right one ahead of time.
Why are my values necessary to the process of making care decisions?
You can never account for all the situations or unexpected moments in life. To plan for every conceivable eventuality would be almost impossible.
However, you can get a deeper sense of what matters to a person and how they would respond in a given situation by understanding their values.
It’s this depth of this understanding of your values that creates a roadmap of who you are.
For example, you may value your independence and autonomy. This will directly influence how much care you receive, and the kind of care given. It may also help inform your carers and loved ones when treatment should be withdrawn.
Or you may value your privacy and being on home turf. In the later stages of life, this might impact how long you stay at home versus being taken to a hospital. The logical decision might be for your family to fight for your right to stay home with minimal care. But this may create risk for your doctors and carers that is too high. Without your express wishes to stay home for as long as possible, your family may lose the ability to keep you at home to avoid risk to the medical professionals treating you. By recording that home is where you want to stay, you give everyone the ability to do what they can to make that happen.
Why will I care what happens if I can’t communicate anyway?
Sometimes, we may lose the ability to share what we think about a given situation or an offered treatment without losing the desire to decide for ourselves. Other times, it may be that you don’t want to leave other people with the stress and strain of deciding for you. Or perhaps what they would decide might not necessarily be what you would choose.
In all these situations, ExSitu is your ally in the trenches. It safeguards your wishes in particular scenarios, such as when you would prefer someone withdraws or maintains treatment. It helps you articulate what you’d like to keep enjoying even if there is some risk attached. Our process can help you explicitly define situations where you have strong feelings. And we help you share the closest approximation of what you may choose in any given situation by helping people understand what you value on a deeper level.
By using ExSitu, you can start to decide what treatment you will and won’t accept, define what quality of life looks like to you, protects your ideals and beliefs from outside influence, and champions the little choices that make you, you. All while saving your family and carers from added stress and strain in the process.
I have a will and I’ve appointed a power of attorney. Is this enough?
No. A will and a Power of Attorney are fantastic documents when it comes to dealing with your belongings and estate in different situations.
Your Will distributes your money, possessions and other particulars once you die. Your Power of Attorney gives a nominated person the ability to make decisions about your property, possessions and financial affairs. Your Power of Attorney can be used prior to death if you lose capacity to make decisions for yourself.
Care plans are for the time spent in your later stages of life. Think of a care plan as your personal safety net for making sure that your needs are looked after from retirement through to end-of-life. And/or if you end up losing the ability to advocate for your own care choices through disability, accident, illness or injury.
Where Wills and Power of Attorney protect assets, care plans protect your quality of life. They help people understand choices such as whether or not you will receive particular medical treatments. Or what your preferences may be when it comes to your day-to-day care or goals that matter to you.
A couple of examples of a scenario you include in a care plan might be:
- You’ve always been immensely proud of your fitness and stamina. It’s important to you to keep up a regular regime of classes, movement and exercise to maintain that. This would be articulated as something you value and integrated into a daily or weekly routine at a care centre
- Nothing beats your amazing little dog, Honey. With Honey by your side, you feel confident and have all the companionship you need. The thought of ever letting go of Honey is unthinkable. Choosing any aged care centre or home care scenario would have to include provision for Honey, too
- You’re OK to have nurses help with most if not all the physical needs you may have. But if you lost the ability to communicate, it would change things dramatically for you. You may refuse more treatments once you can’t communicate than if you could. So, you want to make sure this is written down before this happens.
I hate computers! Can I have your forms mailed to me?
No. But we promise that ExSitu is one of the easiest programs you’ll ever use! You don’t have to install anything or make big changes to access ExSitu. Plus, for a small fee you can also request someone to act as a facilitator to help take you through ExSitu and capture all your information. How great is that?
How long do I have access to ExSitu?
From the time you setup your login and pay the once only fee, you will have 28 days to complete your Hierarchy of Values and advance care plan.
What if I want to update my choices and information?
ExSitu is a single use process in that we do not store your records after the 28 day period. That means any updates to your decisions and circumstances will mean recreating new documents via ExSitu. This is the same for many of the documents used in the later stages of life and with end-of-life care.
We know that life can change and so can priorities. That’s why we keep the price point of ExSitu low. You can recreate your Hierarchy of Values and Advance care plan any time you like.
What kinds of circumstances would mean updating my documents?
The wonderful thing about ExSitu is that the Hierarchy of Values generally stays the same. This is because our values generally don’t shift over time. An example of a change in your values-based plans would be a religious conversion or drastic change of political or faith-based view.
An Advance care plan may be subject to change more readily as you grow older as your relationship with your body changes. You may discover disabilities, illnesses or other impacts you hadn’t anticipated. Or the impact ageing, disabilities and illness may be viewed as far more undesirable in theory than they become in practical reality.
This is part of the reason why ExSitu offers both the Hierarchy of Values and the Advance Care Plan as separate items. You can still maintain the same values while learning more expertise in what you do and don’t want in relation to more specialised care as time moves on.
Do you cater to faith-based care plans?
Yes! We also offer non-faith-based end-of-life planning. Our plans are specifically designed to make no assumptions about your belief systems or your life. They are as equally useful to people from all kinds of different cultural backgrounds, the LGBTQIA+ community and more.
What do I do with my documents?
Share your documents with those invested in your care. This includes your family and your doctor.
Upload your document to myGov.com.au. We at ExSitu firmly believe that the best thing you can do with these documents is to discuss them with your family and have your doctor sign them.
Can I change my documents?
You can login to ExSitu to review and change your documents. We recommend you review your documents at least every three years. Remember to share your updated documents with those that care about you, your GP and upload the update to myGov.com.au
How can my Hierarchy of Values be used ?
Your Hierarchy of Values reflects the things you really value. The document can enable and support discussion between your family, providers of care and provide insight and validation that the decisions they are making are in keeping with your values, even if you can no longer express them.
I’m a health provider. How do I use these documents?
These documents give you direction as to a persons directives should they become seriously unwell. The Hierarchy of Values gives an incisive snapshot of a persons core values and should instruct further care planning. They are your tool to deliver care in true collaboration with your customer.
What is a Facilitator?
A Facilitator is a person or organisation trained to assist you in preparing your documents. They will provide reassurance and explanation of the process should you feel you need help.