Above: UK end-of-life care expert, Les Storey
By Yasmin Noone
The key to providing better end-of-life care in Australia is to boost the confidence, not the competence of residential aged care staff, an international palliative care expert said.
Head of the UK’s national end-of-life care program, Les Storey, believes that education and training – specific to making aged care staff feel more comfortable engaging in ‘death talk’ – must be more widespread throughout the sector if a high standard of end-of-life care is to ever be provided well, across the board.
“There is some good work going on around end-of-life care at the moment but one of the problems is that death is a taboo subject,” Mr Storey said.
“A lot of people prepare wills and make funeral arrangements – making decisions about music, to where they are to be buried or whether they will be cremated – but very few people think about or prepare for the end of their life. For example, who they want to be with when they die, where they want to die, how they want to die and who they want [in the room] around them.
“They might think about it but they don’t talk about it.”
Mr Storey explained how important it is that aged care providers offer dedicated training which aims to “increase the confidence of staff to enable them to engage in conversations with residents about end-of-life care”.
“A lot of the training should be about [the nurse or care staff] following through with some of the questions the resident or older person might have.”
For example, he explained, a staff member might be talking to the resident about future events…”and a resident replies by saying, “Oh nurse, I won’t be here for the next 40 years’. And the nurse says, ‘don’t be silly’”.
This type of question, he said, should be recognised as a clear signal from the resident that they want to talk about the possibility of death with the nurse and may have questions about their end-of-life.
“The issue is not about competence. It’s about confidence. And a lot of that is also to do with the baggage we carry [as individuals] and as health workers.
“We see death as a failure rather than as a natural consequence of life.”
Mr Storey will visit Australia to present a end-of-life care master class on Monday 17 October in Melbourne, Wednesday 19 October in Sydney, 21 October in Brisbane, 24 October in Alice Springs, 26 October in Adelaide and 1 November in Perth.
Presented by Change Champions, the series of full day workshops will see Mr Storey draw upon the UK approach of reducing hospitalisation and providing individual choice for individuals nearing the end of their life.
By the end of the day, participants will have an opportunity to discuss approaches they might wish to consider for their patients/client; be given practical examples of how Preferred Priorities for Care (the UK’s end-of-life care program) has increased individual choice, involved individuals in decision making about their end of life care; gain an understanding of how the UK approach has reduced hospital stays and averted admissions from care homes and increased the opportunity for individuals to die at home if that is their preference.
“In the workshop, we use a lot of case studies and talk about the issues and share information. It enhances the opportunities for people to have a better death,” he said.
“It’s about raising the awareness about what is in the best interests of the residents and [the facility staff] being advocates for the residents.
“If we don’t talk about end-of-life care wishes then there is not much chance that what people want will happen. If we discuss the issues and record their wishes then there will be a better chance that the resident will get what they want.
“A lot of [the workshop] is about identifying any questions that residents might have and following up on them. Basically, it’s about confidence building in end-of-life care discussions and giving people opportunities to practice having these sorts of discussions in a safe environment.
“People have the competence but not the necessary confidence so we are not challenging their but their confidence in applying those skills in different situations.”
After all, he said, “practice makes perfect”.
Mr Storey will also present at the upcoming Aged Care Association Australia’s (ACAA) 30th Annual Congress in early November. For more information click here.