Home' Australian Ageing Agenda : AAA Spt-Oct 2013 Contents Care Australia says increased education
for health professionals about opioids in
palliative care is necessary to address
some of the fear about their use.
"Some GPs, some nurses and other
staff are simply very nervous about the
use of opioids and misunderstand its use
in palliative care."
AN ACTIVE PATHWAYS
Luxford says a static approach to caring
in facilities is also failing residents and
contributes to the distress felt by families
"It's about recognising when people are
dying and taking steps to ensure the best
quality of life until the end," she says.
"If the whole facility is conscious that
a person is likely to die in the next few
weeks, for example, then the whole of the
facility can actually gear towards that and
understand it, and it means that even the
kitchen staff behaves differently in the
kinds of foods they may be preparing for
Luxford says understanding that
palliative care is not just about terminal
care, but support for a person, weeks or
even months before death, will also go
some way to improving care. However
palliative care funding via the Aged Care
Funding Instrument currently does not
support this concept.
"We have to accept that people are
going into aged care with much higher
levels of acuity then what we have ever
seen before, often with multiple chronic
conditions," she says.
Luxford hopes that the new quality
indicators to be published by the My Aged
Care website will include palliative care or
end of life care as a separate benchmark,
and would rate facilities according to a
number of factors including linkages with
skilled GPs, transfers to hospital and
compliance with advance care plans.
To help upskill the general aged care
workforce to deliver care according to a
palliative approach, the Living Longer,
Living Better reform package has assigned
$1.9 million over five years to expand the
existing Program of Experience in the
Palliative Approach (PEPA). A further
$19.8 million will provide specialist
palliative care and advance care planning
advisory services for aged care providers.
Lifting the quality of training through
ongoing, face-to-face education is critical
to enabling a culture shift, says Luxford.
As a relatively young field, advances in
palliative care are rapid and continuous
education for GPs, nursing and care staff
is imperative, she says.
Luxford says the roll out of targeted
training in palliative care must also take
into account the high staff turnover in
aged care and barriers to take up of
To embed higher training standards,
the 2012 Senate committee report into
palliative care recommended including
advanced care training as a component of
the aged care accreditation standards.
In addition to better training for staff,
there are also strong calls for improved
access to specialist palliative care services
to support aged care facilities. However,
the stretched capacity of specialist
services to meet the needs of the
community has meant in-reach services to
aged care facilities have been limited.
The recent Queensland parliamentary
inquiry into palliative care, which handed
down its final report in May, heard evidence
that some specialist palliative care services
are restricting their delivery of services due
to increased demand and that particular
patient groups including residents of aged
care facilities are missing out.
Specialist services in Queensland also
often include a criterion limiting services
to clients with a prognosis of less than
three months, which is difficult for older
clients with non malignant disease to meet.
This trend of restricting access to clients
extends beyond Queensland and was
verified by the PCA as a significant issue.
While specialist services often provide
phone consultations, it is increasingly
difficult for specialists to conduct direct
visits to residential aged care facilities.
To extend the delivery of specialist
palliative care services, NACA has called
for increased government support,
both state and federal, to promote aged
care providers becoming specialists
themselves, given their infrastructure
suitability for provision of hospice care.
To address some of these challenges, new
models such as services utilising the role
of the nurse practitioner are emerging.
For example the Metro South Hospital and
Health Service in Brisbane has established a
nurse practitioner-led residential aged care
facility (RACF) palliative care service that
provides an in-reach service to 76 facilities.
This service has significantly reduced the
number of inappropriate referrals and
admissions to emergency departments.
The hiring of salaried GPs by private
aged care providers, which Bupa has
recently commenced, may also present a
new model to improve access for residents
to GPs and palliative care, says Luxford.
The Queensland parliamentary inquiry
also recommended developing medication
'imprest systems' in facilities as a way
to facilitate the immediate control of
symptoms for palliative care residents. In
the absence of a GP, a medication imprest
system would allow aged care nursing
staff to access medications that are not
labelled or stored for a specific patient but
are available for potential administration,
when necessary, after hours. n
"To die free of pain is
Professor Colleen Cartwright
52 | SEPTEMBER -- OCTOBER 2013 | AAA
Links Archive AAA Jul-Aug 2013 AAA Nov-Dec 2013 Navigation Previous Page Next Page