Home' Australian Ageing Agenda : AAA Jan-Feb 2012 Contents THE PRODUCTIVITY COMMISSION has handed down its report and the
expectation is that we are inevitably moving toward an era of change in
aged care provision. So the theme of the 2012 Tri-State Conference,
Aged Care: The New Frontier, is more than apt.
Dr Bill Silvester is one of the key speakers at the event, to be held
in Albury, NSW, in late February. An intensive care specialist, Silvester
has spent much of his career working with patients hovering between
life and death. He says, in this often emotionally charged environment,
he came to realise the interests of patients and their families would be
better served if their wishes regarding life-prolonging treatment and
cardio-pulmonary resuscitation had been recorded in advance.
In 2001 he was instrumental in developing the Respecting Patient
Choices model at Melbourne's Austin Hospital. It takes a coordinated
Tri-State and ACQ set the
2012 conference challenge
21st Annual Tri-State
Conference & Trade
Exhibition -- Aged Care:
The New Frontier
Intensive care specialist, Dr Bill Silvester
will be outlining his own reform agenda
at the upcoming tri-state conference --
in terms of end-of-life processes. Dale
Fisher spoke to him about his messages
for conference delegates.
Dr Bill Silvester in expert panel
mode, Palliative Care Australia
Conference, Diversity 2011
approach to advance care planning (ACP) where trained non-medical
facilitators, working with treating doctors, assist patients and their
families to document their wishes regarding end-of-life care and
Now this is successfully established in acute care hospitals around
Australia, Silvester has moved his attention to residential aged care
facilities. Since an initial pilot project in 2004/2005, he and his team
have continued to revise their recommendations and now have a
program ready for implementation.
"In respecting our autonomy and dignity as human beings it is
crucial at the end of life, that we are provided with the opportunity to
have a say in how we wish to be cared for," he says.
"Our research has found that a significant number of residents
want the opportunity to talk about end-of-life treatments and they want
the subject raised by health professionals. It also established that
most people want end-of-life care to take place in the nursing home
and that they don't want to be transferred to hospital."
The Productivity Commission recommends that aged care services
require trained staff to implement ACP; so Silvester has submitted
a report to the government outlining a sustainable model and its
implementation, including an education package for staff.
The model, which he concedes will require extra funding,
proposes that registered nurses take on a dedicated portfolio of
ACP and each facility be required to have one ACP nurse for every
30 residents. It recommends that Registered Training Organisations
(RTOs) around Australia be funded to deliver the training, which
involves an online component of six modules followed by three one-
day workshops over six months.
As part of his straightforward approach, Silvester is also advocating
that aged care providers stop asking residents and their families about
their wishes for resuscitation in the event of a cardiac arrest.
"Research both here and overseas shows that in an aged care facility
the chances of survival after a cardiac arrest is so low -- less than one per
cent -- that we believe that offering resuscitation as an option is unethical."
He believes the public has a skewed view of the success of
resuscitation because of the popularity of medical programs like ER
"We suggest that resuscitation is not something that staff should
even talk about, but if it does come up, nursing staff should say that it
is not our policy to resuscitate because it is not uniformly successful.
If facilities took a standard approach on this then the public's
expectation would begin to reflect the reality."
Silvester is also keen to see the acronym NFR (not for resuscitation)
replaced by the more positive AND (allow natural death) throughout the
aged care sector.
At the conference, he will announce the results of a current survey
being conducted in aged care facilities on the knowledge, attitudes
and practices of nursing staff in the area of resuscitation. n
21st Annual Tri-State Conference & Trade Exhibition
Aged Care: The New Frontier
Albury Entertainment Centre,
"In respecting our autonomy
and dignity as human beings
it is crucial that, at the end
of life, we are provided with
the opportunity to have a
say in how we wished to
be cared for."
58 | JANUARY -- FEBRUARY 2012 | AAA
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