Residential aged care facilities should recognise the need for palliative care much earlier to avoid hospital admissions at end of life.
That’s according to Jane Newbound, aged care project manager at North West Metropolitan Region Palliative Care Consortium.
Based at Melbourne City Mission, Ms Newbound works with 170 aged care facilities to improve the palliative care they provide to 12,000 residents.
“Palliative care in aged care is their core business and staff need to be trained and upskilled to provide consistency in care across shifts,” she says.
Ms Newbound’s group helps to improve education in end-of-life care and procedures, including reviewing services and conducting workshops to better identify residents who are deteriorating.
“We also work with hospital in-reach teams to improve acute assessments with emergency department teams and senior aged care staff, to avoid hospital admission from aged care,” she said.
People go into aged care to die
Ms Newbound said that new admissions to aged care are increasingly people with life-limiting illness coming from the acute sector, many classed as ‘”respite.”
People are also staying longer at home longer due to the increasing government support for community aged care, she said.
“When they enter aged care they are older, have greater cognitive decline and more complex medical history, with many needing end of life and high care,” she said.
She argues this has not been addressed by the Federal Government’s definition of palliative care under Aged Care Funding Instrument guidelines which is restricted to “terminal care.”
“The government is not looking at the numbers. It doesn’t pay facilities for effective, anticipatory palliative care until end of life is imminent.”
By comparison, Ms Newbound points to Victorian Government funding for eight regional aged care projects, including her own, to strengthen the capacity of aged care services to provide palliative and end-of-life care.
Implications for aged care
Aged care environments need to be designed for providing mainly end-of-life care – with quiet rooms, places for families to stay and a layout that ensures coffins can leave in a dignified manner, Ms Newbound said.
“The emphasis on building new facilities that look like hotels seem to be more for the children of potential residents,” she said.
“Colours and designs should suit people with cognitive impairment.”
Ms Newbound recommends a whole-of-facility approach where it is the responsibility of all staff – nurses, carers, leisure and lifestyle staff, cleaners and hospitality – to work together to provide good palliative and end-of-life care.
National Palliative Care Week runs 21-28 May and this year focuses on aged care.
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