Manage Dying - Residential Aged Care

Manage Dying

This section reviews resources to assist you in recognising that someone is imminently dying and to provide support for dying residents and their families.

Manage Dying - ELDAC Care Model
Recognising Dying

While individuals may differ in their signs and symptoms of dying there are some common indicators that a person may be in the final days of life. These include:

  • Rapid day-to-day deterioration that is not reversible
  • Requiring more frequent interventions
  • Becoming semi-conscious with lapses into unconsciousness
  • Increasing loss of ability to swallow
  • Refusing or unable to take food, fluids or oral medications
  • An acute event has occurred requiring revision of treatment goals
  • Profound weakness
  • Changes in breathing patterns

Some organisations have a specific care plan for residents in the final days or weeks of life. The use of an end of life care pathway or terminal care plan may help to focus the care required for residents in the last days or weeks of life. palliAGED has a downloadable Practice Tip for End-of-Life Care Pathways for Nurses (pdf 330kb) and Careworkers (pdf 451kb)

The Residential Aged Care Palliative Approach Toolkit (PA Toolkit) has a range of resources available on when and how to use the ‘How to Use the Residential Aged Care End-of-Life Care Pathway (RAC EoLCP)’. It includes:

  • A 26 minute training video using a fictional scenario to demonstrate when and how to use the RAC EoLCP in the end of life (terminal) care of residents
  • A companion learning guide
  • The RAC EoLCP form
  • An information brochure about the RAC EoLCP for relatives and friends
Talking About Dying

Talking about death and dying can be difficult. The Residential Aged Care Palliative Approach Toolkit (PA Toolkit) has a webinar “Someone is dying. What do I say?”

CareSearch provides an End-of-Life Essentials factsheet on discussing the process of death and dying (127kb pdf). Even though the End-of-Life Essentials resources were designed for use in hospital settings, the factsheet provides useful phrases for discussing the process of death and dying.

palliAGED has a downloadable Practice Tip on Talking About Dying for Nurses (pdf 315kb) and Careworkers (pdf 454kb)

End of Life Medications

Assessment and management of symptoms is critical for dying residents. Information around medication is available in the Guide to the Pharmacological Management of End of Life (Terminal) Symptoms in Residential Aged Care Residents (375kb pdf). This guide includes:

1. An overview of key principles guiding quality pharmacological management of end of life (terminal) symptoms.

2. An overview of the roles and responsibilities of residential aged care staff in the provision of optimal symptom control during the terminal phase.

3. A consensus-based list of medications, endorsed by The Australian and New Zealand Society of Palliative Medicine (ANZSPM), suitable for use in residential aged care for the management of terminal symptoms.

4. A table summarising the uses, doses and routes of administration of the medications endorsed by ANZSPM that can be used in the education and training of residential aged care staff.

5. Flowcharts summarising the pharmacological management of four common end-of-life symptoms – Nausea and Vomiting, Pain, Respiratory Distress and Restlessness and Agitation.

Syringe Drivers

A syringe driver are commonly used for symptom management and are used to provide continuous medications subcutaneously when a person is no longer able to swallow.  More information and resources about syringe drivers can be found at this CareSearch webpage.

palliAGED also has information on Subcutaneous Medication Administration.

After the Resident Has Died

There are legal regulations and laws concerning death certification and coronial procedures. Death is to be verified and depending on which state or territory you are in this may be done by a nurse or doctor. Certification of death must occur which is usually by the General Practitioner. In some instances deaths must be reported to the coroner.

palliAGED has a downloadable Practice Tip on After-Death Choices for Nurses (pdf 220kb) and Careworkers (pdf 442kb)

  • Assessment Tools
  • Family Resources

The Residential Aged Care End-of-Life Care Pathway (RAC EoLCP)

Available for download from Metro South Health in Queensland, the RAC EoLCP document is licensed under a Creative Commons licence. There is no cost associated with downloading or using the RAC EoLCP document. However, you must agree to the terms of the licence.

The Residential Aged Care Palliative Approach Toolkit (PA Toolkit)

The PA Toolkit is a comprehensive set of resources for palliative care in residential aged care services offering a suite of information including downloadable and printable documents for supporting families who are dealing with a loved one dying.

  • Information for Relatives and Friends: Residential Aged Care End of Life Care Pathway (RAC EoLCP) is a brochure designed for families giving an overview of the RAC EoLCP and how it helps the care team to deliver the best quality care to a resident in the last days of their life.
  • Understanding the Dying Process Brochure: Explains some of the physical symptoms and emotional changes likely to occur as death approaches and aims to answer common questions about the dying process.

Page updated 17 May 2019