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

1. Guidelines for a Palliative Approach in Residential Aged CareTrainers August 2005

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. What works in education and training for staff in RACFs? • Discuss previous experience. • What worked, what didn’t? • Collate a list of ideas of how to engage staff in an information session

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

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

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

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

13. 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)

14. Three forms of palliative care • End-of-life care • Specialist palliative care services • A palliative approach

15. End-of-life care • Final days or weeks of life • Goals sharply focused on the resident’s 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.

16. 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

17. 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

18. 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

19. 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.

20. 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 resident’s 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.

21. 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?

22. How could these Guidelines be introduced? Flow charts care plans Policies

23. 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.

24. 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

25. Additional training/education and other projects • Opportunities for further training/education • Other projects of interest

26. Conclusion Summary Questions? What Next?