Objective: Examine policies of aged care organisations relating to healthcare and lifestyle decision-making. Methods: Seven aged care organisations submitted policy documents. Policies were analysed using the Australian Law Reform Commission (ALRC) “Decision-Making Principles” as a framework. Senior staff (N = 9) with policy development roles participated in follow-up interviews. Results: The structure and content of policy documents varied significantly between organisations. Most acknowledged the need to support the rights of care recipients in decision-making; however, the nature of this support was often unclear. Interview themes included factors relating to “organisational contexts” “policy development and implementation” and “ethical challenges.” An overarching theme among high-performing organisations was “proactive response aimed at pre-empting decision-making dilemmas”. We provide recommendations for policy development, including a self-assessment audit tool. Conclusion: Aged care provider organisations may need to review policies in the areas of healthcare and lifestyle decision-making to meet current best practice principles.