Honesty the best policy when it comes to palliative care

Aged care providers need to be open about the end-of-life services they can and can’t provide and refer elsewhere when necessary, writes Larissa McIntyre.

It is widely recognised and acknowledged that palliative care is one of the most fundamental aspects of our work in residential aged care. Ensuring a person reaches the end of their life with dignity and comfort goes to the heart of what we do.

Throughout last week’s National Palliative Care Week, we were invited to consider what matters most to people. Part of this is how to best tackle the difficult conversations that ensure residents and their families experience the best possible outcomes for their specific palliative care needs.

One of the most important issues in the aged care sector is capacity including building capacity for palliative care in residential aged care and encouraging providers to think about how they can build capacity for palliative care and sustain this in their facilities.

This requires honesty; honesty with ourselves and honesty with the people we care for. All the money in the world could flow into the Australian aged care industry and residential aged care would still be unable to care for every possible type of need in palliative care.

Various centres have different resources, specialties and capacity and one facility may be better equipped to handle some types of palliative care than another.

Every time we are approached by a prospective resident and their family, we should be asking ourselves two key questions. After we ask a person and their family about their expectations of us, we should then ask ourselves with complete honesty “Can we meet these expectations?” and “Do we have the right skill mix to meet their specific care needs?”

That’s what matters most. It is of the upmost importance that all of us in the aged care sector remember without distraction or fail that residents’ wishes are central to all that we do.

Having open and honest conversations about what the resident expects and wants from their care and taking the time to honestly evaluate and understand how to best facilitate them may include referring them to a different care facility better able to meet their individual needs.

From the perspective of the resident, the idea of seeking a facility that best suits their particular needs is not unusual or stigmatised in the broader health industry. For instance, if a local hospital discovered a patient was experiencing a neurological issue, a difficult pregnancy or a nasty burn, they would commence basic procedure and refer them to the hospital with the skill in that area and the capacity for the clinical management of that particular condition.

That does not say to the local hospital isn’t a good institution or doesn’t have excellent clinical staff. But rather it means there’s another hospital that is particularly good at providing the type of clinical care a person needs.

The same holds true for palliative care in residential aged care. Maybe we need to recognise that not every facility can meet every care need of every resident and consider inter-sector referrals.

Trust is key

Given Australia’s ageing population, aged care facilities are aiming to please ever-increasing numbers of potential future residents by offering almost every service related to palliative care.

Occasionally they fail to live up to the promises they’ve made due to limits in that facility’s capacity, such as skill mix, knowledge or equipment. This breaks the crucial fundamental trust that should exist between palliative care providers and the resident and their family.

Trust and honest communication between aged care providers and residents and their families are among predominant issues we are seeing highlighted at the aged care royal commission. It is vital that the aged care industry considers these factors more carefully or it will continue to wreak havoc on the sector’s public standing.

Residential aged care facilities should be looking at the resources available to them, such as location, equipment, clinicians and staffing mix, and determine where their strengths lie. When a palliative resident’s needs match those strengths, a facility should accept them. But when their needs do not match those strengths, the facility should offer to help find another and more suitable option.

We need to hasten the process of reducing competition between various aged care brands and create a sector-wide culture of collegiality and referrals, building networks to ensure that the people who approach us have the best possible chance of finding the specific type of care they want and need.

The referral process is crucial to give the resident and their family peace of mind and ensure they receive the best possible outcome.

It is vital that aged care operators recognise the importance of opening up to these difficult and honest conversations and commence the hard but necessary work of transforming the provision of palliative care for the better.

Larissa McIntyre is executive care manager at BaptistCare Orana Centre and a conjoint lecturer at University of Newcastle’s School of Nursing & Midwifery.

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