Palliative Care in Residential Aged Care: An Overview

This article provides an overview of palliative care in residential aged care facilities. It discusses the importance of palliative care in improving the quality of life for elderly patients and explores the role of advanced care planning and directives in palliative care. The article also examines the legal and ethical issues surrounding palliative care provision and highlights the contemporary issues facing palliative care in aged care facilities. Finally, it suggests ways to improve the provision of palliative care.

Running head: AGED CARE 1
PALLIATIVE CARE
Name
Course
Date

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Introduction
The population in the society is aging and more people living with the wrath of severe
chronic illnesses. Residential aged care provides a wide choice of care provision and
accommodation for old people living independently in their residential homes. Such is palliative
care. In Australia, the National Palliative Care Program is dedicated to providing extensive
service improvement in the country for the last decades. Palliative care is under residential aged
care in the country and is supported by the Commonwealth government and governed by the
Aged Care Act of 1997. The National Palliative Care was endorsed by the government in 2010
on the influence of Commonwealth and state and territory governments to implement policies
and strategies for people nearing their end of life stage. End of life stage refers to the end times
of life for a person who is suffering from life-limiting illnesses and is speedily approaching
death. Life-limiting illnesses are chronic which are incurable and patients suffering from this
have little to no prospect of life. Palliative care is hence dedicated to improving the lives of these
patients as their end of time approaches by treating symptoms that may be physical, spiritual or
social. This involves personal care unit and 24-hour provision of nursing care to many old people
who are becoming frail and unwell in their homes. To get admission to an aged care home, one
needs to contact the Aged Care Assessment Services which will, in turn, send a healthcare
provider to access the necessity and eligibility for approval. A wide range of accommodation and
care options now exist for elderly people getting hardships living independently. According to
Mitchell (2011), Urgent care services ought to be provided to cater for the multi-faceted
requirements of this generation of the elderly. Palliative care forms a crucial model of residential
aged care as discussed below.

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Palliative care provision
One of the approaches to providing care in Aged care facilities is through the delivery of
palliative care. WHO defined palliate care as a methodology directed to increase the quality of
life for equally the patients and close family members by taking care of impediments correlated
to life-threatening illnesses. This includes the liberation of pain and misery through the prompt
diagnosis of the illness, and impeccable assessment of other non-curative treatment that will
improve on the physical, social, and physiological needs of the patient.
Quest (2011) describes palliative healthcare as a methodology that is aimed at improving
the life class of patients facing attributed to life-threatening ailments through prophylaxis and
relied on suffering. Mitigation of patients suffering can be through an early diagnostic of
infections, impeccable assessment, and treatment. Palliative care is a necessary necessity for a
society which is progressively getting composed of the old. Palliative care purposes at improving
the quality of medical life for elderly people by improving their dignity care and living
conditions.
How palliative care is applied in residential aged
Palliative care is not just a process but an integrated philosophy for the overall care of
the patients and family. This permits efficient interaction and provision of healthcare between the
aged care team and the patients and the patient's family. Palliative residential aged care is
delivered in different ways liable to availability of resources the geographic location. Care
provision includes consultations to larger hospitals and patients receive the palliative care on the
basis of necessity and not prognosis. Palliative care; Acknowledges life's mortality and regards
death as an unavoidable normal process, the care neither postpones nor hastens death. It focuses
on Providing pain relief and other distressing symptoms assimilates the psychological social and

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spiritual facets of care and presents a support system for patients’ family members cope with the
sickness and in their own grief.
Pain management
The torture of physical pain is the most ill-fated part of plentiful healthy conditions
nearing the end life stage. Other than the physical pain, pain is also inclusive of social,
physiological, or spiritual pain. Though universal, palliative healthcare ensures not all will
experience the pain. In a journal, by Hello Care (2018), the first principle that is used by
palliative healthcare is a full assessment of the origin of underlying pain and then executing the
steps for pain relief. WHO recommends when pain occurs, it should be given by the clock rather
than on demand and should follow the older; non-opioids like paracetamol and aspirin, mild
opioids like codeine and last strong opioids like morphine until a patient is liberated from the
pain.
Palliative care helps patients living with terminal illnesses such as cancer, heart disease,
dementia, and other ill term illnesses live comfortably as possible at the end of life stage of the
patient. The team of health care professionals work to their level best in providing a wide range
of care services tailored to the specific needs of the patient. Apart from the residential aged care
facility, Palliative care can be provided at homes, hospitals, hospice, or palliative care units
Discussion on Advanced care planning (ACP) and Advanced care directives (ACD) in palliative
care
Crispin (2015) defines advanced care planning as the process of permitting persons to
plan ahead prior to any forthcoming loss in a decision-making capacity. Advanced care directive
is a document that any resident makes while still in the well-being capacity and the documents
can be utilized once he or she can no longer make the decisions especially in old age. The

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documents outline what the resident would want and under which circumstances, points out the
person who can make medical, a lifestyle of financial decision for the patient, and can be
changed whenever the resident wishes to change them. Crispin feels that the person sought to be
presented with the opportunity to brand their ACD and document stored safely prior to being
taken in residential care. The advance care planning involves four steps; critically thinking
oneself preferences and values, discussing the preferences with the trusted spokesman,
documenting the preferences into advance care directive and finally reviewing the document
periodically.
Both ACP and ACD help greatly in residential aged care and palliative care help
eliminate unnecessary pain, procedures, and unwanted hospitalization. Advanced care directives
allow the appropriate transfer of information amid the patient and the healthcare practitioner
once in the patient is in residential care. When the resident is not in the capacity to make own
rational decisions, the document assist the family members the nurse, and other healthcare
providers to make a decision in line with the resident's wishes
Critique of the issues in advanced care planning and applying advanced care directives in
residential aged care
Patients may not usually wish to think about their end-stage life nor develop the advance
care planning and advanced care directives as nobody wished of dying. ACP can as well causes
immature distress and destroy future hope of living. Lund (2015) review shows that advanced
care planning and advanced care directives do not necessary tools to effectively create a solution
to the effectiveness of the provision of end of life in residential care. ACP needs the
incorporation of other clinical settings, such as palliative care, to completely complete the
demands of residential care. Lack of proper understanding within the community and persons

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lead to an inappropriate decision concerning the care of end of life. Many people fail to make
rational ACD that will govern their end of life care. Failure also for the health provider to
understand the terminal nature patient conditions result in inappropriate treatment and worst
cases worsening of the condition. This reduces the potential benefits that may come with
palliative care.
Legal issues in palliative care provision
Advanced care directives are legal documents which acknowledge individual medical
decision about their care, the county is supported by both the common law and statute law. the
statue law lies in the legislative framework and will vary from state to state (different in various
territories) Dominique (2016) compares Advanced Care Directives in New South Wales against
Southern Australia and affirms the inconsistency of the Australian Legislation as far as legal
requirements of the ACD are implicated. The common law is depended on jurisdiction made by
judges in case law. General common principles governing Advanced Care Directive include;
Apart from emergency cases, it is a battery law to inflict any Medical action or care
without the contest of the patient.
Every competent being in the capacity to make a decision is right to take or refuse any
kind of treatment that may be given now or in the future.
Formal advanced care directives are only legally valid if the person giving this is or was
competent with rational decision-making capacity. Unless the judicial declaration of
incompetence, adults are generally assumed to be competent as capable of making their own
decisions (BeŠireviĆ, 2010).
Sometimes the advanced care directives may not contain entirely the patient's preferences
to control decision making to the current issue at hand. In such a case, a substitute decision

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maker is called upon to brand decisions on behalf of the patient. In some cases where the patient
had not identified a substitute decision maker in the ACD, a dispute may often arise within the
family members on who to make a medical decision. In such cases, the Attorney is called to
appoint on one of the close members who vividly understand the patient's preferences. Decision
makers are outlined in the statute law on the procedure of appointing one from the hierarchical
family members for becoming the substitute decision maker
Ethical issues in palliative care provision
Rendering to laud (2015), Advanced Care Directives are dependent on the notion of self-
autonomy which he outlines as the power to govern oneself. Autonomy gives the patient the right
to control how their treatments or care to be provided depending on their preferences. Karnik
(2016) strongly insist individual’s right to autonomously air their end of life treatment need to
ethically considered and respected in advance to patient treatment or prognosis. Each patient has
his own preferences concerning how their healthcare should be provided and these preferences
should not be assumed. If a medical decision needs to be made and the patient has not outlined it
in the ACD, the substitute decision-maker should be called upon and the healthcare practitioner
should not make the preference solely. A substitute decision-maker should have a strong
understanding of the patient's preferences they are advocating for.
For decades, ethical challenges facing the health care organization at large have been
reported. Palliative care, it is not an exception. Patient consent in palliative care must be sought
in all the medical treatments. Advanced care directive provides an ethical guideline on when to
withdraw or withhold life-sustaining treatment. ACD negotiate the patient decision on whether
to or not to carry on with life-sustaining treatment like resuscitation, artificial feeding, artificial
ventilation among others. In such a situation an ethical dilemma arises amidst healthcare

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provider. Karnik (2016) insist mutual agreement between the physician and the patient need to
be reached to ensure no harm is caused and again honoring patient preference.
Healthcare providers need to understand medical preference will vary from patient to
patient. It is hence unethical to assume universal palliative care for all residents in the Aged
Care. Beneficent actions, which Carter (2012) discuss as the guiding principles which guide any
healthcare provider in doing what is ethically right or wrong. It is the role of health practitioners
to ensure that the resident's medical decisions are maximized
A research review by Mamhidir, (2017) shows a number of care providers worked in a
hurried manner which failed to address the person’s needs of each patient. Lack of appropriate
medical care was also mentioned to occur in a case where the patient was poorly assessed or
received inappropriate medication from the poorly trained personnel. HDM told the ethical
dilemmas involved with a stained condition in elder care,
Some vulnerable patients are also placed in an inappropriate care setting. An ethical
dilemma found was a situation where a patient suffering from mental disorders were placed in
inappropriate environments it is unprofessional for a patient with dementia to live in a mixed
care setting with other people who are not suffering from the condition.
Contemporary issues facing palliative care provision aged care issues
Insufficient Funding
Palliative care providers in Aged Care facilities have long protested about the subsidiary
provided by the authority is way far to meet the sectors operation cost. Arguments have also
claimed that the existing financing programs are not committed in investment on capital
infrastructures and there are insufficient funds to upgrade n existing ones. Residential funding is
subject to complex means testing arrangements. There is also the difficulty of developing

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equitable funding across the provider. The sector is very sensitive in the country and lack of
funds forces many to depend on pensions to support their funding.
Insufficient Workforce
Provision of quality palliative care is highly dependent on the availability of adequate
and highly skilled staff. However, the country is currently faced with a trained workforce
problem. Australia is currently facing a huge workforce deficit. Many aged care providers
find difficulties in recruiting and retaining workers. Desiree from Nazareth Care Australasia
agrees it's a challenge to find satisfactory registered and qualified nurses especially remote
areas.
Heavy Regulation
Ostaszkiewicz (2016) fears the overprotection surrounding residential aged care. Aged
care in Australia constantly receives high-rate regulation compared to other industries.
Commonwealth regulates all aspect of aged care and some of the regulation can be termed
unnecessary. The model can be abandoned to allow more consumer choice and competition in
the sector.
Ways to improve palliative care provision
Quality improvement
Brandyn (2015) defines quality improvement as an effort to improve or change the
structure, processor means on which palliative care is being administered. Such strategies include
the provision of friendly policy or specific quality improvement interventions. Examples may
include changing how the residential aged care audit patient clinical data such as in the
implementation of AdvanceCare Directives, providing multifaceted of quality palliative care for
Patients with complexity in illness delivering timely care among others. Implementing such

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policies may help maximize the provision of palliative care. In his study review, Brandyn(2015)
found quality intervention succeeding in improving the excellency of palliative care being
provided in residential aged care.
Improved consultation and communication
The palliative care team should improve communication skill with the patient and family
members to get their views and medical preferences. The interaction helps to build on physical,
social and emotions needs which are key factors in the provision of palliative care improving on
Palliative care consultation team brings encouraging impression and the patient together with the
family members feel they get involved in the provision of treatment. Through debriefing,
discussing health progress, sharing medication provision strategies, explaining the drawback and
benefits of specific medication are some of the way health care providers can improve in patient-
nurse relationships.
Innovation and technology
Innovation is also a key solution to the amelioration of key issue facing aged care. This
involves innovation in areas of customer experience, change in models of operations. There can
also be understating of new technology to aid in facilitating aged care provision. A new
technology that can aid in palliative care provision includes Paro Therapeutic Robot which is a
robotic machine containing a number of socializing and stress management tools in older
patients. Heath care practitioners should embrace the utilization of the ever growing technology
in improving the care that is being provided
Funding Palliative care in Homecare
Home care or so-called domiciliary care is a social care provision in people's homes. This
includes helping in washing them, dressing them, preparing and feeding the sick. Some

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individuals will be eligible to cater to the cost for the home care provision. Person-centered care;
which means the personal needs are personally taken care of in an integrated and holistic way.
In order to avoid the mayhem in residential aged care, more policy should be developed
to encourage patients to stay at home. The government should amend the policy on home care
package policy in favor of the homecare packages and reduce residential target. The government
has announced the additional A$ 1.6 billion funding in the 2018- 2019 budget, to buy up 14000
additional home care packages. This will meet the needs of aged Patients who wish to stay at
their homes.
Community and staff training
The staff providing palliative care needs extensive training. This involves strategies to
improve symptoms assessment and medication delivery. There is a need for specialist palliative
care that will provide precise care for people suffering from different ailments
Bennett (2018) mentions on ensuring health staffs are continually equipped with skills,
training, and experience to ensure they do their jobs effectively. Members of the community
should also be trained to get sufficient understanding about the benefits of quality and affordable
local care. More campaigns should focus on the promotion of need of local community and
social groups on embarrassing topnotch homecare.
Lack of proper community knowledge lead to inappropriate care at the end of life of
many patients, when people hear of palliative care, it inflates an emotional and confronting
sensation. Many people may get afraid when they are told they are in need of palliative care for
their fast time. It is a common misconception that people receiving palliative care are at the end
of their lives. However, this should never be the case. Communal education should be conducted

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to help patients to see the good quality life that waits for them rather than counting their days and
sees It is the final one under the palliative healthcare.
Conclusion
A palliative care provider can significantly reduce the patient's risk of avoidable
emotional, physical and social discomfort if well implemented in the residential aged care.
Despite being charged with numerous problems, aged care is an essential model of healthcare
provision to the growing population. We need to develop a measure for the quality of palliative
care provided to our patients to ensure it improves.

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