2015 BCCPA Annual Conference Panel Presentation: “Revisiting End-of-Life in Canada” Pat Porterfield, RN, MSN Funded by the Michael Smith Foundation for Health Research | BC Nursing Research Initiative 1

Resources for the Integration of Long Term Care and Palliative Care The following slides guide you to resources on this topic developed by two research initiatives: iPANEL—Initiative for a Palliative Approach in Nursing: Evidence and Leadership, a BC Nursing Research Initiative, Michael Smith Foundation for Health Research Improving Quality of Life for People who are Dying in Long Term Care Homes, a Community University Research Alliance funded by the Social Sciences and Humanities Research Council (SSHRC) of Canada. Developed the The Quality Palliative Care in Long-Term Care Homes (QPC-LTC) Alliance to create LTC specific resources.

iPANEL publications on esp. relevant to residential carewww.ipanel.ca Integration of a Palliative Approach in Home, Acute Medical, and Residential Care Settings: Findings from a Province-Wide Survey iPANEL investigators have conducted a mixed-methods province-wide survey of registered nurses (RNs), licensed practical nurses (LPNs) and health care workers in three settings: acute medical units, residential care facilities and home care settings. Survey results provide descriptive information relevant to implementing a palliative approach to better serve the needs of people with advancing chronic life-limiting conditions Dying to Care: How can we provide sustainable quality care to persons living with advanced life limiting illness in British Columbia? The iPANEL advisory board report, Dying to care: How can we provide sustainable quality care to persons living with advanced life limiting illness in British Columbia, was released in June 2014 and contains key recommendations for action. A palliative approach to care of residents with dementia An article describing an interprofessional pilot workshop for direct care providers which aims to incorporate a palliative approach into dementia care for residents.

iPANEL Webinars related to a palliative approach in residential care – Integrating a Palliative Approach in Residential Care: The Holy Family Extended Care Experiment – The Knowledge Translation of a Palliative Approach – Integrating a Palliative Approach into Dementia Care – Integration of a palliative approach in hospital, residential, and homecare nursing: Results of a province-wide survey And more…..check the iPANEL website and newsletters….

A “snapshot” of the iPANEL Webinar: A Knowledge Synthesis on a Palliative Approach 5 5  An understanding of a palliative approach can guide us in integrating palliative care into various settings including residential care.  Our synthesis resulted in describing three themes that are essential features of a palliative approach in all settings of care : Conceptual foundations of a palliative approach: a knowledge synthesis. Sawatzky, R., Porterfield, P. et al—Paper submitted for publication. April 2015

Improving Quality of Life for People who are Dying in Long Term Care Homes ( ) The Quality Palliative Care in Long-Term Care Homes (QPC-LTC) Alliance Outcomes:  Promoted LTC culture change in whole organization: LTC Homes: Providing Care for Life  Developed framework for developing inter-professional palliative care programs specific to LTC including 40+ resources downloadable at no cost.  Created partnerships between LTC homes, community organizations and researchers to improve quality of life of residents to the end of life.  Promoted the role of the Personal Support Worker in palliative care

Comprehensive Palliative Approach to Care in LTC: Resident Journey from Admission to EoL Stable Transition End of Life Time of Death Bereavement Pre admission ACP & PC education Adapted from CHPCA Model of Care, 2013 by QPC-LTC PC brochure

Quality Palliati8 Framework for Implementing Palliative Care in Long Term Care Homes

Improving Quality of Life for People who are Dying in Long Term Care Homes ( ) Personal Support Worker Role PSWs provide the majority of the bedside care to residents at the end-of-life in LTC, but their role and contribution in PC was not clearly defined. A set of PSW competencies for palliative care in LTC were created that outline their role and scope of practice to guide interprofessional communication, and PSW inclusion in decision-making: – what is the PSW qualified to do? – how is the PSW role distinct from /value added to the other professional roles? PSW empowerment and inclusion in developing the palliative care program is key to creating a sustainable culture incorporating palliative care in LTC Educational opportunities promote PSW empowerment

Additional LTC Resources

11 Website: New National Curriculum for Palliative Care in Long Term Care (LEAP LTC)

LEAP LTC Modules Proposed Time for module Being Aware40 minutes Taking Ownership and Who is the Team75 minutes GI, Hydration and Nutrition60 minutes EOL Decision Making and Dilemmas60 minutes Advance Care Planning60 minutes Psychosocial Support 60 minutes Essential Conversations30 minutes Delirium, Dementia and Depression 60 minutes Pain I and II120 minutes Palliation of Dyspnea and Other Symptoms in Chronic Illnesses90 minutes Last Days and Hours Working with Families 60 minutes Grief and Suffering: What to Say and Do45 minutes The Challenge: Organizational Readiness30 minutes

Learning Essential Approaches to Palliative care for Long Term Care LEAP LTC Now booking courses, various formats available Seeking new facilitators for this curriculum from across the country, including BC. Information is available on the Pallium website: or by contacting Natalie Gravelle-Ray at