Two aged care providers are renewing the call for more coordinated approaches to advance care planning in aged care and ensuring a greater emphasis on older people’s wishes at end of life.

BaptistCare’s Orana Centre on the NSW Central Coast has been implementing advance care plans for over a decade. When it first began in 2004, none of its residents had an advance care plan – now 70 per cent of residents do, with aims to get that figure to 90 per cent.

Lara McIntyre, the Orana Centre’s executive care manager told Australian Ageing Agenda it was important that the aged care industry acknowledge that managing death and dying was “core business”.

“When people come into residential care, the majority will die in your facility,” she said. “So how do we make sure that their death is done well and that they also have some input?”

“We need to be able to talk about it in all its forms. We need to be able to give good clinical care at the end of life, even leading up to that. We need to be comfortable around what death actually is,” said Ms McIntyre.

Lara McIntyre
Lara McIntyre

The Orana Centre had gradually moved away from a solely medically-focused approach to advance care plans and towards more person-centred approaches that also broadly captured a resident’s values, beliefs and end-of-life wishes, said Ms McIntyre. This could include requests such as visiting the beach one last time or reconnecting with family members, and was important for both the resident and their family in dealing with death, said Ms McIntyre.

At the Orana Centre, conversations about advance care plans begin with the resident and their family at pre-admission. Ms McIntyre said it was important that advance care plans were done early – before the terminal phase of an illness or in an emergency – so people could feel calm making decisions, and that conversations involved straightforward language.

She stressed that doing an advance care plan with residents was not a ‘tick and flick’ exercise and that staff must continue to make themselves available and provide resources for people who may be challenged by conversations about death or the dying process. It was also important to review advance care plans regularly, as often people may change their mind about certain aspects of the plan, she said.

Advance care planning and palliative care would become a bigger issue for the aged care sector as people stay in their homes for longer and residents come into residential aged care frailer, she said. “Residents don’t stay with us for as long as they used to,” she said. “The norm is getting closer to somewhere between six to 18 months.”

National approach needed: Benetas

Another aged services provider raising the issue of advance care planning in aged care is Victorian-based organisation Benetas.

Jenny Davis, a project manager with the provider, last week told the Australian Association of Gerontology national conference that access to end-of-life care was a human right and needed to be made a national health priority.

Ms Davis said the current system did not allow enough respect to paid to people’s choices about their death. While 70 per cent of people would like to die in their home – including their residential aged care facility, only 14 per cent are able to, she said.

“More emphasis should be placed on respecting the person’s wishes, enabling the person to be cared for in a familiar environment surrounded by people who know and love them, and being in the right care environment” she said.

There needed to be a national policy approach, as a lack of guidelines were leading to stress and uncertainty in decision making, and potentially unwanted or unwarranted treatments, Ms Davis said. Currently, legislation around advance care planning varies between states.

“We need a coordinated and national approach in the development of standards in the use of terms, documents, and legislation particularly in the context of an ageing population, increasing chronic disease, and higher consumer expectations of quality care, increasingly to be provided in the ‘home’,” she said.

The broader community also needed to be provided with more education around advance care planning and how to access local and state services, Ms Davis said.

Resources to guide aged care organisations are available at the Decision Assist website, at Advance Care Planning Australia, and at Palliative Care Australia.

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1 Comment

  1. Excellent to see this in the public domain and obviously extended from the highly watched QandA session on monday night.

    The subject of ACP is not as easy as many might think and indeed it is not as simple as a tick and flick form. There are numerous barriers that exist in preparing an ACP for a client and these include, the knowledge and competency of the clinician to identify the triggers that indicate the need and to be able to manage the difficult conversations that sit around this issue.

    Many clinicians are not confident with the right time and right approach, and often fall trap to the “its too early” or ” the client is not ready”. However the research and evidence tells us differently. Usually the client believes the clinician will raise the issue for discussion, and the clinician believes the client will choose the time to ask the question. So we are left with a catch 22 and poorly planned care that usually ends in a downward spiral that becomes emotionally charged and complex, if the planning and decisions are not in place.

    More training for clinicians in these areas of difficult communication and counselling for their clients, more education for the public on the details, benefits and rationale for this healthcare issue, and more funding to provide better partnerships in quality care at the end of life.

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