“Dangerous and premature” recommendation

The national peak body for providers of palliative care says the National Health and Hospital Reform Commission’s (NHHRC) recommendation on advanced care planning in its interim report is “dangerous and premature”.

Palliative Care Australia is concerned because the report proposes that Commonwealth funding be made available for the national implementation of the Respecting Patient Choices (RPC) program for advanced care planning in residential aged care.

Austin Health in Victoria has adapted the RPC program from the US-developed Respecting Choices program.

Palliative Care Australia’s CEO Donna Daniell said she welcomed further funding and coordination for advanced care planning in residential aged care but she is worried by the commission’s decision to promote the roll-out of one particular program.

“The commission should have recommended a proper national system for advanced care planning in residential aged care facilities,” said Ms Daniell.

“That’s a gigantic leap away from recommending the national roll-out of one proprietary model.”

However the the program’s director, Dr Bill Silvester said it was misleading to describe it as proprietary because Austin Health had never gained any money from the program.

“It is based on principles that are well espoused around the world,” said Dr Silvester.

“It’s simply a model that we are recommending simply because it worked for us.”

Austin Health introduced the RPC program as a pilot at the Austin Hospital in Melbourne in 2003.

In 2004-05 it implemented the program at 17 aged care facilities and two palliative care services within its catchment area.

An evaluation of the implementation project conducted by La Trobe University found that the RPC program promoted ‘dying in place’ and helped to improve staff skills and confidence in the area of advanced care planning.

The program has since been extended to one lead site in each state and territory with funding from the Department of Health and Ageing.

Despite this Donna Daniell said there was not enough evidence about the RPC program to mention it specifically in the recommendations.

“There are still questions about whether the level of human resources needed to implement it properly are actually available,” she said.

“Australia should not invest in signing up to the national roll-out of that product because we believe it may not be sustainable.”

But Dr Silvester said the program had been implemented successfully at a number of aged care facilities.

“The way we developed it is using a train the trainer model,” he said. “The staff from the aged care facilities come in and are trained in how to do advanced care planning and then they go and do the planning as part of their normal work.

“We found that it was not labour intensive at all and we feel that in that way, it is completely sustainable.”

Ms Daniell said she hoped the wording of the recommendation would be changed in the final report.