End-of-life Planning Framework supports strengthened Aged Care Quality Standards
A guest blog post by Professor Liz Reymond MBBS (Hons), PhD, FRACGP, FAChPM. Director, caring@home project
Most older people would prefer and benefit from care focused on their unique goals of care and quality of life rather than care aimed at extending biological life.[1] This patient-centred approach can prevent burdensome treatments and unwanted hospital admissions. It can support Australians who wish to receive palliative care in their home, whether in an aged care facility or in the community.[2, 3]
With the recent passing of the Aged Care Bill by the Australian Parliament, the new Aged Care Act will commence on 1 July 2025. The Act will support changes that make it easier for aged care providers and workers to focus on delivering safe, high-quality palliative and end-of-life care.
With the Draft Aged Care Quality Standards [4] in circulation for some time, and the Aged Care Quality and Safety Commission indicating any further changes are likely to be minor, providers should already be aware of the reforms and be reviewing their current practices to ensure they align with in the new Act.
The Draft Standard Outcome 5.7 states that providers must ensure the older person’s:
- needs, goals and preferences for palliative care are recognised and addressed, and their dignity is preserved
- pain and symptoms are actively managed with access to specialist palliative care when required
- family and carers are informed and supported, including during the last days of life.
The new caring@home Prompts for End-of-Life Planning (PELP) Framework guides proactive, quality end-of-life care across all care settings and can be used by residential aged care and home care package providers in achieving the Draft Outcome 5.7 in practice.
The PELP Framework is based on work undertaken in the UK [5] and Australia.[6] It was developed to support health professionals to proactively manage their patient’s care as it transitions from curative to palliative, and to facilitate a high-quality end-of-life care according to the patient’s preferences.
The PELP Framework invites health professionals to identify patients at risk of deteriorating and dying and then to trigger comprehensive discussions regarding the person’s goals and wishes for care. These ongoing discussions enable preparation of person-centred management plans that align with the person’s wishes and reduce the need for decision making in emotionally charged reactive situations.
The PELP Framework identifies four clinical end-of-life processes:
- Advance care planning and person-centred care based on need (at risk of dying)
- Transition of focus of care needs from restorative to palliative (likely to die soon)
- Terminal care needs (dying)
- After-death care (bereavement).
Under each clinical end-of-life process are a list of prompts for the health professional to consider given the person is in that stage of their illness trajectory.
Implementation of the PELP Framework into routine practice can help aged care services provide quality person-centred care; care that is aligned with patients’ preferences and delivered at the right time and in the right place, while also meeting clinical, legal and ethical challenges associated with caring for people in the last 12 months of life.
The PELP Framework was developed by caring@home, a National Palliative Care Project, funded by the Australian Government. It has been developed in collaboration with a National Advisory Committee, including Palliative Medicine Specialists, Nurse Practitioners, General Practitioners and Nurses.
Contact: www.caringathomeproject.com.au / caringathome@health.qld.gov.au / 1300 600 007
Note: Outcome 5.7 incorporates principles from the National Palliative Care Strategy [7], National Consensus Statement: Essential elements for safe and high-quality end-of-life care [8] and the National Palliative Care Standards for All Health Professionals and Aged Care Services.[9]
References
- Swerissen H, Ducket J. Dying Well. Melbourne: Grattan Institute; 2014.
- Scott I, Mitchell G, Reymond E, Daly M. Difficult but necessary conversations - The case for advance care planning. The Medical Journal of Australia. 2013;199(10):662-6.
- Foreman L, Hunt R, Luke C, Roder D. Factors predictive of preferred place of death in the general population of South Australia. Palliative Medicine. 2006;20(4):447-53.
- Australian Department of Health and Aged Care. The strengthened Aged Care Quality Standards - Final draft. Canberra 2023.
- Gold Standards Framework London. 2015 [Available from: https://www.goldstandardsframework.org.uk/].
- Reymond L, Cooper K, Parker D, Chapman M. End-of-life care: Proactive clinical management of older Australians in the community. Australian Family Physician. 2016; 45(1/2):76-8
- Australian Department of Health and Aged Care. National Palliative Care Strategy. In: Care AGDoHaAC, editor. 2018.
- Australian Commission on Safety and Quality in Health Care. Essential elements for safe and high-quality end-of-life care National Consensus Statement. Sydney; 2023.
- Palliative Care Australia. National Palliative Care Standards for All Health Professionals and Aged Care Services. Canberra: PCA; 2022.
Professor Liz Reymond
Director, caring@home project