It takes a village: expert calls for community involvement in palliative care
European experience has confirmed that community-based palliative care reduces unnecessary and costly hospital treatment, an international palliative care specialist has told Australian aged care providers.
European experience has confirmed that community-based palliative care reduces unnecessary and costly hospital treatment, an international palliative care specialist has told Australian aged care providers.
Dr Emilio Herrera, a Spanish palliative care specialist, recently presented a financial analysis that showed a home-based palliative care approach was saving health systems millions where it has been introduced.
Dr Herrera has developed the We’re All With You (Todos Contigo) movement in Spain and throughout other European cities and South America to meet the repaid increase of chronic illness facing countries with an ageing population.
Speaking at the recent Palliative Care Victoria conference, Dr Herrera said that rather than looking for miracles when a loved one was dying at the end of a long-term chronic illness, people needed to plan to meet the person’s emotional and physical needs, with the support of their community and not just health professionals.
Dr Herrera said that for every euro invested in the community-based palliative care program, five to six euro was saved in alternative more intensive acute and emergency hospital care.
His approach saw the person placed at the centre, surrounded by family, carers and the community, and then social and health services – all working together to ensure quality end-of-life care.
The community training he has developed explained what palliative care was, how to find and access resources, the needs of people at the end of life and promoting understanding of illness and grief.
It also covered practical skills such as being able to use a wheelchair and moving a dependent person safely around the house. As well as emotional support, it taught people how to speak with terminal patients.
Greater role for families in residential-based palliative care
Dr Herrera’s concept also applied to people who will die in residential aged care facilities, where he said families and the community needed to play a bigger role.
He conducted a study of 900 people in residential care and discovered more than 42 per cent had depression and more than 55 per cent felt isolated “because they felt their relatives and friends had forgotten them.”
Dr Herrera’s model acknowledged that some patients with complex needs would need long-term hospital care within his person-centred integrated care model, but again this would be delivered with the individual at the centre.
“The centre is not the palliative care team. It is the patient, their neighbours and community and we have to then provide the benefit of professional services they need, depending on the needs of the patient,” he said.
Odette Waanders, CEO of Palliative Care Victoria, said there was strong interest in building “compassionate communities” in Australia.
“The early work in this area originated in Victoria where Alan Kellehear was head of the La Trobe University Palliative Care Unit, which has a public health approach.
“With regards to much greater integration of health and social models of care, we still have a long way to go and are yet to see a concerted effort on this front,” she said.
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