The full role and impact of palliative care in residential aged care (RAC) is unknown. This is despite the high level of need for palliative care in the RAC sector. Approximately 60,000 people die in RAC in Australia every year, often within months of admission.
The Palliative Care Outcomes Collaboration (“PCOC”) is a national outcomes and benchmarking programme that leads to statistically and clinically significant patient outcomes, through a systematic and standardised assessment process. Nurse leadership and involvement in PCOC is essential to the success of the programme. The potential of the use of PCOC in the RAC sector is emerging and under evaluation.
The overarching arm of the broader project is to adapt and evaluate the PCOC programme for use in the RAC sector. PCOC’s assessment and response protocol is implemented in RAC to identify, assess and respond to the symptoms and needs of palliative residents and their families in order to improve outcomes and end-of-life choices for aged care residents.
The adaptation resulted in the 5 validated PCOC assessment tools being recommended for use in RAC facilities. However, a modified Assessment & Response Protocol was found to be essential, with care workers to complete daily assessments of symptom distress under the supervision of nursing staff. The response protocol also had to ensure an escalation protocol for care workers and response protocol for nurses, in order to ensure adequate palliative care, and supporting good practice.
In the RAC sector where the resident to nurse ratio is vastly different to other palliative care settings, the involvement of the care staff “the eyes and ears on the ground” to identify and escalate clinical need informed by validated outcome measures is possible. Benefits include a communication tool for care staff to advocate for residents in distress, effective use of a large resource (the care staff), and improved access for residents who need palliative care.
Funding Acknowledgement
This project is a collaboration between PCOC, the Australian Health Services Research Institute and Aged Care Providers, and is supported by funding from the Wicking Trust and the Australian Government Department of Health.