Provide Palliative Care
Palliative care is person and family-centred care provided for a person:
- with an active, progressive, or advanced disease
- who has little or no prospect of cure
- who is expected to die, and
- for whom the primary goal is to optimise the quality of life.
Palliative care helps people live their life as fully and as comfortably as possible with a life-limiting or terminal illness. It identifies and treats symptoms which may be physical, emotional, spiritual or social. [1]
Providing palliative care in residential aged care seeks to ensure the best quality of life for an older person when death is inevitable. Palliative care is integrated into the overall care of an older person. This also involves support of their family and carers. There are eight core principles that will help the older person in residential aged care that support palliative care. These are:
- Older people’s physical and mental needs at the end of life are assessed and recognised.
- Older people and their families and carers are involved in end-of-life planning and decision-making.
- Older people receive equitable and timely access to appropriate end-of-life care within aged care facilities.
- End-of-life care is holistic, integrated and delivered by appropriately trained and skilled team members.
- The end-of-life care needs of older people with dementia or cognitive impairment are understood and met within residential aged care.
- Older people and their families and carers are treated with dignity and respect.
- Older people have their spiritual, cultural and psychosocial needs respected and fulfilled.
- Families, carers, team members and older people are supported in bereavement. [2]
The older person’s care plan should be updated to reflect their palliative care needs. The four domains identified in the Assess Palliative Care Needs section of this Toolkit are also used here. The domains demonstrate how to meet the palliative care needs of the older person and their family and carers.
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Physical wellbeing
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Social and occupational wellbeing
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Psychological wellbeing
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Spiritual wellbeing
This section includes links that provide a range of information on the management of common symptoms:
Appetite Problems
- palliAGED has Practice Tips on:
Bowel Problems
Delirium
- CareSearch Clinical Evidence has information on delirium.
Difficulty Sleeping
Dyspnoea (Breathing Problems)
Fatigue
- CareSearch Clinical Evidence has information on fatigue.
Eye Care
Nausea
- CareSearch Clinical Evidence has information on nausea.
- palliAGED has suggestions for the best course of action and developing a treatment plan for nausea.
Oral Care
Pain
Wound and Pressure Care
The Palliative Care Needs Assessment Guidance considers the whole family and carers as the unit of care. When addressing social and occupational wellbeing for an older person with life-limiting illness, their family and carers should be considered. It is important to understand the person’s concerns in relation to their family and carers, emotional and social support, and any practical issues.
Providing person-centred care supports quality of life for older people and enables them to live meaningful lives based on what they value.
- palliAGED has Practice Tips on Person-Centred Care for Nurses (213kb pdf) and Careworkers (334kb pdf).
- The Agency for Clinical Innovation has a video on caring for carers. Consider the role of specific team members in helping to support the older person. This may include pastoral care workers, social workers, and lifestyle team.
Older people with life-limiting conditions frequently experience psychological concerns, such as depression or anxiety. This may be shaped by their:
- mood and interest
- adjustment to illness
- resources and strengths
- pain (total pain)
- pre-existing mental illness.
After identifying that an older person has significant psychological needs:
- Consider the role of additional psychological intervention for older people, such as counselling through psychologists/social workers, or specialist mental health services.
- Consult with relevant team members, like the GP, about appropriate use of medication, where this may be indicated for an older person.
For guidance about responding to psychological needs:
It is important to understand an individual’s beliefs, cultural perspectives, and ways of finding meaning and purpose. This will help care workers and clinicians to be sensitive, respectful, and inclusive in their care of the older person and their family and carers.
- palliAGED has Practice Tips on Spiritual Care for Nurses (239kb pdf) and Careworkers (305kb pdf).
- The Agency for Clinical Innovation has videos on spiritual and cultural aspects of palliative care, including the place of spiritual care at the end of life.
- Eliciting an older person’s life biography can assist in providing person-centred care and meaning-making. This is particularly helpful for people living with cognitive impairment or dementia. A range of tools can be used to create the person’s biography. Your service may already have a template as part of the admission and assessment process.
- The Lasting Tale webpage from Palliative Care Australia (PCA) includes resources to create a life biography. These include a free audio life story app and examples of life story questions to ask older people.
- Gain a better understanding about delivering palliative and end-of-life care by listening to the ELDAC podcast series 'The What to do, When and How'.
- Watch the ELDAC Assess Palliative Care Needs educational video to help in response to the four domains of wellbeing used in a palliative care assessment. The video discusses the importance of care planning to support person-centred, holistic palliative care.
- Use the ELDAC Case Study on Dorothy to build your understanding of how to provide palliative care across the four domains in the framework. The domains include physical, social and occupational, psychological and spiritual. This ELDAC Case Study can also be utilised as part of a group discussion or exercise within education or professional development sessions.
- The ELDAC Our Diversity webpage has information and resources about providing palliative for diverse groups and their specific needs.
- The free Equip Aged Care Learning Modules are produced by the Wicking Dementia Research and Education Centre at the University of Tasmania. A range of aged care related topics are covered, including palliative and end-of-life care.
- The Agency for Clinical Innovation hosts a free palliative care video library. These videos were developed with Australian healthcare specialists to assist in the delivery of appropriate palliative care. There are videos on topics for physical and clinical, psychological, and spiritual and cultural.
- palliAGED offers the Education on The Run training videos. The videos were developed for aged care workers and cover topics related to providing palliative care:
- The palliAGED Introduction Modules for Aged Care for aged care nurses offer training on understanding palliative care symptoms and care issues. There is a companion manual with more details about the education fundamentals. The topics related to providing palliative care include:
- person-centred care
- pain management
- symptom management
- care issues.
Palliative Care Australia
Palliative Care Australia has a comprehensive website devoted to aspects of receiving palliative care, including:
- What is Palliative Care? brochure has information about who palliative care is for; where it is provided; and who is part of the palliative care team.
- Factsheets for families about palliative care (available in 21 community languages).
- 10 questions (895kb pdf) to ask about palliative care in residential aged care.
palliAGED resources for families
This webpage provides information about receiving palliative care in residential aged care. There are links to other resources that may be helpful.