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Palliative care provides high quality health care to people living with a life-limiting illness to live as well as they can by focusing on their physical, psychological, cultural, social and spiritual needs. Palliative care that takes a person-centred approach to care will ensure all resident needs are met.
All residents identified as at the end of life using the SPICTTM tool should have a palliative care needs assessment. The life experiences of a person such as age, culture, religion, ethnicity or experience should be considered.
Re-assessment should occur regularly and at key transition points in the resident’s trajectory, for example:
palliAGED offers complete sets of downloadable Practice Tips for Nurses (pdf 1.9MB) and Careworkers (pdf 2.9MB).
The Palliative Care Needs Assessment Guidance was developed by the National Clinical Programme for Palliative Care and is a framework that considers needs across four domains:
If your service uses electronic notes you may already have these domains within your clinical system. Similarly, your hard copy notes may address these issues. Review your system and see if all the domains are covered. Within each of these domains there are some specific tools or scales that might be useful to understand the needs of the resident and their family. The Assessment Tools section provides information on these domains.
Each resident will have an individual symptom profile and a comprehensive assessment is required.
The Symptom Assessment Scale (SAS) can be used as a self-report tool and provides a report of whether a symptom is present and indication of impact of that symptom. The SAS is based on a rating scale of seven common symptoms and has space to add additional symptoms. The Palliative Care Outcomes Collaboration (PCOC) has a brochure explaining the Symptom Assessment Scale (168kb docx).
Where a symptom has been identified further assessment using valid and reliable tools, if available, should be used to identify the underlying cause of the symptom and further details. The following is a suggested list of tools for common symptoms. You may have some of these in your electronic or hard copy files.
Also The Palliative Care Bridge has a video on assessing pain for people unable to communicate.
This domain is based around family support, emotional and social support and practical concerns.
A comprehensive social assessment helps to identify family, emotional and social support. The use of a genogram is helpful, particularly if the resident’s family is large or there are a variety of different individuals that will be providing support. The Residential Aged Care Palliative Approach Toolkit (PA Toolkit) has an example of a genogram in the booklet entitled The Palliative Approach Toolkit: Self-directed learning packages (10MB pdf) on pages 70-73.
The resident’s life biography assists in providing person-centred care, particularly for residents with cognitive impairment or dementia. There are a range of tools that can be used to identify the person’s biography. The Personal Life History Booklet (357kb pdf) is one resource. You may already have this or something similar as part of your admission and assessment process.
Residents at the end-of-life should be assessed for any issues that are worrying them. In particular, awareness of the possibility of psychological concerns such as anxiety, depression or previous mental health issues.
The final domain is about assessing the spiritual needs of residents. CareSearch gives an overview of spiritual support in palliative care and palliAGED also provides a summary.
A person’s spiritual care includes faiths, cultures, beliefs, and traditions and is the right of older people to express their spirituality in a way that is meaningful for them. The identification of spiritual needs and offering of basic spiritual care is the responsibility of all aged care workers and should be done in ways that are appropriate to their role.
Meaningful Ageing Australia developed the National Guidelines for Spiritual Care in Aged Care, (831kb pdf) which gives an overview of some key spiritual needs of older people, including the five domains of spiritual care.
Page updated 17 October 2019