Home' Australian Ageing Agenda : AAA Spt-Oct 2014 Contents Alasdair MacDonald Jeannine Lew
We live in a society that
values freedom of choice
and decision-making. The
right to make choices
about our health and
medical needs and to accept or refuse
medical treatment is an integral part of this.
In 2009, the social work team at Sir
Moses Montefiore Jewish Home in Sydney
reviewed residents' preparations regarding
health and lifestyle decisions about their
end of life. It was identified that while
most residents were generally prepared in
terms of having sorted out financial affairs,
many had typically not considered their
health and lifestyle choices. It was also
observed that difficult underlying family
issues and challenges often surfaced
around end-of-life care and treatment
decisions, which could possibly have been
avoided with prior support and discussion.
As a result, advance care planning
(other terms include advance care
directive, plan of care or personal wishes
statement) became a focus for the facility
to help ensure that every resident and
their family would have the opportunity
to consider and communicate their end-
of-life care and treatment decisions in a
supportive and caring context.
The intention in introducing ACP was to
enable residents and their families to have
choices around their own end of life care.
The underlying rationale was that it would
reduce stress, anxiety and depression for
both residents and their relatives, and that
such discussion would enable residents
and family members to prepare for this
time, both emotionally and practically.
The program developed at Montefiore
was in collaboration with residents and
families, and includes the following elements:
• Social work team consultation with
external specialists on the legalities and
complexities concerning ACP.
• Resident and family dialogue which is
encouraged and facilitated by the social
worker around these difficult issues either
six weeks post-admission, or annually for
existing residents. Multiple discussions
and follow-up are often required due to
the sensitivity of the subject.
• A plan of care, which is the document that
sets out a resident's personal and health
care decisions, and is completed by their
person responsible when the resident has
lost cognitive capacity and therefore the
ability to make their own decisions. To
ensure compliance, it is critical to establish
resident's cognitive capacity as a diagnosis
of dementia does not mean loss of capacity.
• Once the ACP is completed, the social
worker makes sure the whole care team
is aware of it.
• An information package with definitions,
legal implications, explanatory booklets
and forms was developed for residents
and their families.
• Education evenings about ACP provide
residents and families the opportunity
to ask questions of an expert panel,
including palliative care specialists,
nurses and social workers.
• Residents and families are encouraged
to consult with external practitioners,
such as their GPs, palliative care
specialists, and relevant Spiritual Dean.
• Clinical staff is trained to understand
ACP processes, forms and alerts.
• ACP is included in the home's palliative
care processes and revisited when a
resident's health changes or declines.
Since introducing an advance care planning
program at Montefiore, we have identified
a number of benefits including improved
support for residents and an opportunity
to articulate their end-of-life wishes. ACP
provides residents peace of mind that their
end-of-life wishes will be respected and
peace of mind for families in terms of not
having to make difficult end of life care and
treatment decisions in a crisis situation.
The ACP program has also offered an
opportunity for residents to reflect and
discuss with families what is important
to them and how they would want to
be cared for if they could no longer
communicate or were dying.
A survey conducted in 2011 of 88
residents and 88 families found 40 per
cent of residents completed an ACP; 71 per
cent of families found it enabled their parent
to have a more peaceful and comfortable
end of life; and 82 per cent of residents and
relatives stated the process enabled valuable
family dialogue that was helpful in reducing
trauma and stress at a difficult time
Five years post implementation, the
effectiveness of our ACP model addressed
what had previously been a difficult and
emotional time for residents and families
close to end of life.
While end-of-life discussions can be
stressful and distressing, it does enable
residents and families to prepare for this
time, emotionally and practically. ACP
also empowers residents with end-of-
life wishes, and facilitates the process of
understanding their values and beliefs in a
calm and supportive environment. n
Jeannine Lew is social work manager
and Alasdair MacDonald is customer
assurance manager at Sir Moses
Montefiore Jewish Home.
End of life
of mind ACP provides residents peace of mind that
their end-of-life wishes will be respected.
Advance care planning at Montefiore is
offering residents an opportunity to influence
their end-of-life care wishes, write Jeannine
Lew and Alasdair MacDonald.
48 | SEPTEMBER -- OCTOBER 2014 | AAA
Links Archive AAA Jul-Aug 2014 AAA Nov-Dec 2014 Navigation Previous Page Next Page