Presented by Sallie Fredericks Nurse Consultant Palliative Aged Care Consultancy Service (PACCS)

Background 50,000 Australians die each year in residential aged care facilities. Palliative and end of life care should be core business for aged care services. (Productivity Commission 2011).

Why Focus on Palliation? “That people with a life-limiting illness can live until they die in an atmosphere of care and support”. “There is a widespread recognition that the benefits of palliative care are not limited to the final days and weeks before dying”. (Guidelines for a Palliative Approach in Residential Aged Care)

Rationale: Hospital admissions were common towards end of life Late recognition that a resident may be dying Discussions around death where not attended until the resident was actively dying was common Family members often had to make decisions about care when the resident was very sick. Symptoms were not planned for so comfort medications were often not available

Focus: A specialised care program focused on key areas to implement a palliative approach to care: Specialist palliative care staff visiting Aged Care Facility weekly Engagement with GP’s- building trust and confidence Improving the attitude, knowledge and skills of staff Review of the systems that were in place to guide the palliative approach

ACTION: Palliative Care staff attended thorough assessments of all residents who were approaching the terminal phase. Symptoms that were commonly reviewed were pain, anorexia, dyspnoea, cachexia, nausea and vomiting, depression, dysphagia, mouth discomfort, bowel care and skin care. Plans were then made to manage these symptoms through liaising with GP’s and Port Kembla Palliative Care Team if necessary

Advance Care Planning Case conferencing and discussions with family, residents and General Practitioners that emphasised and promoted the resident’s quality of life and dignity. Ensuring care plans are formulated that focus on the individual symptoms of the resident.

Debunking Myths Found to be many misconceptions about Morphine, Palliative Care etc. Education was provided to all staff on the palliative approach and the specialised care program. The education focused on symptoms experienced, how to recognise the symptoms causing distress and how to manage them. Education regarding the myths and misconceptions regarding Morphine etc. were held regularly

OUTCOMES: GP Satisfaction?? Planning Reduction in crisis care Residents more comfortable Less residents going to hospital and dying there reduction by 2/3Rd Confidence in care from residents and relatives Staff knowledge and “comfortability”

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