Guidelines for a Palliative Approach in Residential Aged Care Trainers August 2005

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Guidelines for a Palliative Approach in
Residential Aged CareTrainers August 2005
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Rationale for introducing a palliative approach
in RACFs

• Industry driven
• Valuable tool
• to achieve the demands of consumers
• enhance staff skill base
• ensure a consistent approach
• The unique needs of residents

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How were the Guidelines developed?

• APRAC project team
• Consultation with Key Stakeholders
• Funded by the Australian Government Department of
  Health and Ageing through the National Palliative
  Care Program

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Your role

• Discuss the terms champion and resource
  person
• Consider how to engage and lead your RACF in
  implementing the Guidelines
• The Residential Aged Care Palliative Approach
  Network

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Supportive strategies

• A one day workshop
• A Training and Resource Kit containing
• Copy of the Guidelines and Navigational Tool
• A PowerPoint presentation on CD
• Manual with notes and activities to accompany
  each PowerPoint slide, hard copy of the
  Powerpoint slides and resources
• A video discussing the palliative care approach
  and the Guidelines
• Members of the Network will be linked with local
  palliative care service(s) at the Residential
  Aged Care Palliative Approach Network workshops

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Supportive strategies continued

• 4. Online bulletin board for Network members
• 5. Four issues of an online and hard copy
  Newsletter- experiences related with
  implementation of the Guidelines
• 6. Information sessions for members of the Boards
  of Management and managers

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The Guidelines and Standards

• Palliative Care Australia Standards
• Aged Care Standards And Accreditation Agency-
  Standard 2 Health and personal care- 2.9
  Palliative care The comfort and dignity of
  terminally ill residents is maintained

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What works in education and training for staff in
RACFs?

• Discuss previous experience.
• What worked, what didnt?
• Collate a list of ideas of how to engage staff in
  an information session

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The Guidelines

• What are guidelines?
• Format of the Guidelines
• The depth and breadth of the Guidelines
• How do you read the Guidelines?

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The Navigational Tool

• The purpose of the Navigational Tool
• The format of the Navigational Tool
• How to use the Navigational Tool

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Introducing Guidelines

• Identify barriers to introducing the Guidelines
  and strategies to overcome any issues
• Identify what will be the most important issues
  for staff

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Definitions

• Palliative Care
• End-of-life (terminal) care
• A palliative approach
• Specialist palliative care service
• Primary care
• Life limiting illness

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What is palliative care?

• An approach that improves the quality of life
  of individuals and their families facing the
  problems associated with a life-threatening
  illness, through the prevention and relief of
  suffering by means of early identification and
  impeccable assessment and treatment of pain and
  other problems, physical, psychological and
  spiritual
• (World Health Organisation Definition of
  Palliative Care 2002)

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Three forms of palliative care

• End-of-life care
• Specialist palliative care services
• A palliative approach

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End-of-life care

• Final days or weeks of life
• Goals sharply focused on the residents physical,
  emotional spiritual comfort and support for
  family
• Difficulties arise with determining if a resident
  is moving into a terminal phase with
  co-morbidities - requires discussion about
  needs/wishes with the individual/family.

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Specialist palliative care services

• Provide specialist input to patients with complex
  end-of-life care requirements and needs
• Provide consultation (information/advice) on
  complex issues in partnership with primary care
  service/practitioner
• Interdisciplinary team provides additional
  resources
• 3 broad groupings

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A palliative approach

• Improve quality of life
• Physical, spiritual, cultural, psychological,
  social
• Open approach to death and dying
• Includes caring for the family
• Active treatment for a disease is still
  appropriate

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Benefits of a palliative approach

• What are the potential benefits of a palliative
  approach for
• residents and their families
• staff
• Discuss possible misconceptions/ concerns about a
  palliative approach in RACFs

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When should a palliative approach be implemented?

• Guideline No 1
• Methods used to identify survival time have
  limitation in accuracy and precision, and are
  therefore not recommended. Rather, a combination
  of active treatment to manage difficult symptoms
  while continuing to follow a palliative approach
  is considered best practice.

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Where should a palliative approach be implemented?

• Guideline No 2
• Implementing a palliative approach in RACFs can
  reduce the potential distress to residents and
  their families caused by a transfer to an acute
  setting.
• Guideline No 3
• A palliative approach can be provided in the
  residents familiar surroundings if adequately
  skilled care is available.
• Guideline No 4
• Providing information about a palliative
  approach may help residents and their families to
  consider a palliative approach as active care
  rather than withdrawal of treatment.

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Who should implement a palliative approach?

• Guideline No 5
• A multidisciplinary team that promotes goal
  setting in collaboration with the family is
  critical to the success of a palliative approach.
  This approach decreases discomfort for residents,
  saves valuable resources and improves
  satisfaction levels for the family when they
  recall the care provided.
• What is the role of the local specialist
  palliative care service in an RACF introducing a
  palliative approach?

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• How could these Guidelines be introduced?

Flow charts
care plans
Policies
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Selection, implementation and support for
Guidelines

• How to select the Guidelines to be introduced?
  What do you need to consider?
• How to implement the Guidelines in a facility?
• How to engender support for the Guidelines in a
  facility?
• Consider strategies for working with staff at a
  higher level.

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Resources and support

• Associations and National Groups i.e. Palliative
  Care Australia
• Local specialist palliative care services
• Online bulletin board on CareSearchwww.caresearch
  .com.au
• Journals
• Websites

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Additional training/education and other projects

• Opportunities for further training/education
• Other projects of interest

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Conclusion

• Summary
• Questions?
• What Next?