Over the last 5 – 10 years there has been a shift in the complexity of the person entering Residential Aged Care (RAC). The chronic diseases and co - morbidities that are present in our communities are now reflected in the RAC setting. This change is also evidenced by the shift of core business in RAC from lifestyle support and accommodation to death and dying.
To review the palliative care of Mr. W, who was admitted to RAC with a primary diagnosis of end - stage liver disease secondary to Hepatitis C.
There was a three-step process: 1. a full case review of the clinical file was undertaken; 2. interviews with the clinicians involved in his care; and 3. a clinical reflection session with the clinicians involved in the care of Mr. W.
The review highlighted the extreme complexity of Mr W who presented with Hepatitis C, previous intravenous drug use who was being managed on methadone, multiple chronic conditions, anxiety, depression and a complex social history. Mr. W died within 6 - weeks of admission to the RAC.
The most challenging aspect of Mr. W’s care was managing his pain. The review highlighted the effective partnerships between the RAC clinicians and the local health district clinicians. Surprisingly, it also highlighted the families poorly understood concept of palliative care and the impact of this knowledge deficit in the final days of Mr. W’s life. However, this deficit was not recognized and fully comprehended until after his death.
The key learning was the importance of the “conversation” in the acute sector prior to RAC admission, to better prepare families for this final stage, is essential. And importantly ensuring clarification with the families as to their understanding of “palliative care” when admitted to RAC.