Palliative care knowledge increasing in residential, but concerns community care behind

Early evaluation of Decision Assist has found significant increases in staff knowledge and confidence, but suggests community care lags behind residential in some areas of implementation.

An initial evaluation of training delivered to aged care workers by Decision Assist, the national initiative to enhance palliative care and advanced care planning, has shown significant increases in their knowledge and confidence.

But the early data also suggests that community care lags behind residential in some areas of implementation.

Decision Assist is a federally-funded initiative between health and aged care organisations, including Leading Age Services Australia (LASA) and Aged and Community Services Australia (ACSA), that provides advice and training to improve the palliative care and advance care planning expertise of aged care staff, practice nurses and GPs.

Chair of Decision Assist Associate Professor William Silvester told the LASA National Congress this week he believed advance care planning would soon form part of the accreditation process and he warned providers to get on board or risk getting left behind.

Diana Cooper, the national aged care training coordinator for Decision Assist, discussed the early evaluation of the training program, which will continue to roll out until June 2016.

“In an era of consumer-directed-care, it’s imperative that we meet the palliative care and the advanced care planning of the ageing population,” said Ms Cooper. “Aged care reforms have seen enormous changes… with the increased number of home care packages, we’re seeing people coming into aged care now much older, much frailer and much more co-morbidities.”

The training consists of six online modules, two interactive workshops held two months apart, and workbooks for participants containing multiple resources. Training is state-specific and based on existing evidence-based resources. Workshops have been running for residential aged care workers since September 2014 and for community care workers since June this year.

As part of the evaluation of the program, participant’s knowledge, confidence, attitudes and practice were measured.

Early results showed increases in participant knowledge in relation to recording of end-of-life decisions for residents with dementia, knowledge of end-of-life care pathways and signs of approaching death.

But measures of participants’ efforts to facilitate or participate in advanced care planning and palliative care activities within their organisation between the two workshops highlighted differences in uptake between residential and community care workers.

Community care struggling

“There is very little difference between doing an advance care plan for newly admitted clients or existing clients between residential and community. But what we see is the community is struggling very much with palliative care case conferences and completing the advance care planning form,” said Ms Cooper.

Ms Cooper said the evaluators of the program were looking closely as to the potential reasons for this, but suggested it may be that residential providers had more opportunity for education on palliative care and advance care planning in the past.

An audience member said it had been a challenge getting uptake of advanced care planning in community care as the Decision Assist program was rolled out at the same time that CDC was introduced, an issue which Ms Cooper acknowledged.

However, the initial results also showed that around 94 per cent of both residential and community workers agreed the Decision Assist program had increased their confidence levels to recognise whether or not a resident or client had less six months to live.

“It’s slow, but it’s happening and it’s happening a lot more than it was two years ago,” said Ms Cooper.

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Tags: advance-care-planning, Bill Silvester, decision-assist, Diana Cooper, lasa2015, palliative care, William Silvester,

5 thoughts on “Palliative care knowledge increasing in residential, but concerns community care behind

  1. Advanced care planning falls into the area of “Difficult Conversations” for care providers , workers and clinicians.

    Health professionals need specific training and education to first identify the triggers that indicate to them that the need for engagement in the difficult conversation is imminent. Usually it includes the validation of assessment that identifies the reflection of care directives used in care support plans. The question all health professionals should ask themselves is “Would I be surprised if this client was to die in the next 12 months”?

    If the answer is No then the clinician should prepare to engage the education and transformation in partnership with the client to establish the advanced care directives and clear instructions for when the client is unable to direct the care needs and outcomes.

    Palliative approaches are important pathways in long term assisted care as we can plan the care needs as directed long before we loose the connection with the client and decisions are made in their interest and by their request.

    Good planning allows good outcomes, prevents unwarranted admissions to curative care and provides a partnership that can be trusted and respected for all concerned.

    The Decision Assist and PalliAged app is great place to start and should be supported with client and careworker education. I would suggest that all care professionals also undertake skills in counselling and Case Management to support their confidence in these “difficult Conversations” and build stronger partnerships in care.

    when we focus on the IPE standards and competency we end up with much better care

  2. Watch the adverse outcomes increase and the level of knowledge go backwards without RNs onsite 24/7.

    LASA and ACSA have serious identity issues and very short memories. You cant vigorously support the removal of RNs from aged care one month and then fly the flag for promoting increased skills and knowledge the next.

    Its a great initiative and a worthwhile pursuit…but all those workshops and Apps aren’t going help the dying person at 2 am when their only carer is an untrained immigrant worker with poor english and no clinical support.

    Maybe we need a federally funded initiative that simply focuses on fundamentals?

  3. Wow, interesting comments. We at the Groundswell Project have been running our 10 Things to Know Before you Go workshops in communities and with medicos and have found that it’s the context of the knowledge provided in end of life planning education that makes the difference between feeling confident and taking action towards having those difficult conversations. One needs to dig inside themselves and consider their own values and fears as well as consider their own agency for empowering themselves and others. And to know they’re not alone! There’s a movement of empowered death talkers, inviting us to join. I personally have heard some great stuff about Decision Assist training in my engagements in the sector, my question is what next?!

  4. I think the headline that community providers of in-home care are lagging behind is somewhat unfair and disingenuous. This article was the first my organisation had heard of Decision Assist as a project or resource, and a straw poll of several colleagues in other similar organisations confirmed that this support hasn’t reached regional areas or smaller providers. The article states that ” Workshops have been running for residential aged care workers since September 2014 and for community care workers since June this year”, but there has been no workshops for community care workers in our area from June to today. It seems to be setting us up to fail by not providing the support for us to improve (using your own measurements), then report that we are lagging behind. We have our own clinical tools and procedures that have been developed based on existing good practice and standards, and that we feel work well for our workers and clients. If these weren’t considered as flavour of the month in the recent measurements, my concern is that community providers are being unreasonably labelled as ‘lagging behind’ when we are actually matching residential providers in the race, just on a parallel track.

  5. I think the issue in the Community is probably more about scope of practice. If someone is identified as palliative in the community agencies such as RDNS or a palliative car service would be referred to. Direct Care Workers and Case Manages in the Community cannot be experts at everything and should not be expected to be.

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