Kate Swetenham, Nursing Director, Palliative Care Projects, Department for Health and Wellbeing.

The Comprehensive Palliative Care in Aged Care Project Agreement is a joint funded initiative between the Australian Government Department of Health and the Department for Health and Wellbeing SA and aims to expand models of care or new approaches to the way palliative care is delivered or commissioned in residential aged care.

The project goals are to:

• Design and implement Models of Specialist Palliative Care to support aged care residents with complex symptoms.
• Design and implement Models of Shared Care between Specialist Palliative Care Services General Practitioners, the residential aged care sector workforce and Non-Government Organisations where appropriate; to improve access and support the delivery of palliative care for residents and their families in RACFs.
• Design and implement models for providing education, training, assistance and mentoring for the residential aged care sector workforce to support the delivery of palliative care for residents and their families in RACFs.

To assist in the identification of the enablers and barriers to delivering the project goals, a project framework¹ was developed and a literature review² and stakeholder analysis undertaken to provide a foundation for the project.

The principles of the project follow the Integrated Management System Framework from the Southern Adelaide Local Health Network’s Clinical Improvement Unit, which is applied to the aged care sector and is underpinned by 5 domains that provide a balanced way of measuring performance: Safety, Quality, Delivery, People and Cost.¹

The deliverables within the framework are based on the National Palliative and End of Life Care Partnership; 2015. Ambitions for Palliative and End of Life Care: A national framework for local action 2015-2020.³

The Framework

Safety (staff focus)

Staff providing end of life care in residential aged care feel safe and prepared to care for those at end- of-life within their facilities.

Quality (Resident focus)

Each resident has fair access to good end of life care, regardless of diagnosis, location and life circumstances. They are looked after by staff who bring empathy, skills and expertise so that they experience competent, confident and compassionate care.

Delivery (Service focus)

Each resident experiences coordinated care where they receive the right help at the right time by the right people. Care is team based and the resident has access to support at any time.

People (The resident and their family)

Each resident is seen as an individual who is an active participant in their care. They are provided with all the necessary information, advice and support that they may require to make all decisions but in particular their end of life decisions.

Cost (The system)

Palliative care is a basic human right and all measures should be taken to ensure full access to symptom management treatments are readily available to all residents of aged care facilities.

Understanding the current context

To understand current models and experiences a literature review and stakeholder analysis were conducted. The literature review focused on the following topics;

• Advance care planning, decision aids and end of life conversations with the older person.
• Emergency Department presentations for Residential Aged Care residents.
• Models of care in particular older people dying in aged care homes.
• Medication access

The grey literature, in particular the expert statements and submissions to the Royal Commission for Aged Care Safety and Quality were reviewed.

The Stakeholder analysis ran concurrently with the literature review and 45 individuals contributed to discussions held either face to face or via telehealth/telephone.

The stakeholders were asked to reflect on the strengths and weaknesses of education and training for the aged care workforce as well as to identify models of care that they found to be worth exploring further.

Participants indicated that palliative care training should be included within the Certificate III and IV education modules and that endorsed end of life decision making tools such as ‘My Life Decisions’ and the 7 Step Pathway should be promoted for use across all facilities within the state and be incorporated into aged care sector training. Regarding models of care, the in-reach specialist palliative care models were often mentioned as was the use of telehealth.

Quality improvement and Research

The Palliative Care Outcomes Collaborative (PCOC) has recently been trialled in residential aged care facilities in New South Wales.

This project will provide the opportunity to support those services that are keen to explore the quality improvement aspect of PCOC within their aged care facilities.⁴

Research opportunities will be present throughout the life of this project and giving consideration to the possible questions that could be answered through this work from the outset will enable projects to be structured in a way that facilitates a greater understanding so that evidence based practice underpins models of care development and the delivery of education and training.

The Research Centre for Palliative Care, Death and Dying focus on palliative care across the health system, death and dying across the community and online evidence and practice translation. Advancement in medical skills and public health interventions mean that most people are living long and healthy lives and that most deaths are expected in a context of increasing age or a life limiting progressive illness.⁵

This project will map back to the framework and stakeholder engagement will continue for the duration of the project to ensure all initiatives continue to meet the needs of the aged care sector.

As opportunities arise for research then these will be explored to ensure an evidence base underpins future investment.

References

1. Daily management system at Tier 1 2018 – Southern Adelaide Local Health Network (SALHN) Continuous Improvement Unit.
2. CareSearch/Research/Older Persons accessed throughout June 2020 https://www.caresearch.com.au/caresearch/tabid/678/Default.aspx.
3. National Palliative and End of Life Care Partnership; 2015. Ambitions for Palliative and End of Life Care: A national framework for local action 2015-2020
4. Palliative Care Outcomes Collaborative Aged Care Fact Sheet July 2020.
5. Research Centre for Palliative Care Death and Dying website accessed July 31 2020.