Analytical Report on Palliative Care in Residential Aged Care Settings

Analytical Report
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Introduction
Palliative care in Australia is defined as a group of approaches that improves the
quality of life of patients and their families facing life-limiting illness, through prevention and
relief of suffering (Australian Institute of Health and Welfare [AIHW], 2018). This can be
done by means of early identification, assessment and treatment of pain, other physical
problems, psychological issues and spiritual distress. While delivery of palliative care is not
the primary role of residential aged care facilities, they are well suited to delivery of such
services. Residential aged care is designed for older people who can no longer live at their
home. This kind of services provides round the clock support to older adults like the
accomplishment of daily living activities and personal care (AIHW, 2018). The Victorian
State Government (2019) highlights that for terminally ill patients such as cancer patients,
procurement of palliative care under the residential aged care settings is of prime importance.
The following report will analyse current issues associated with delivery of palliative
care in residential aged care settings. The report will start with a detailed explanation of
palliative care provision in residential aged care settings. This will be followed by a critical
analysis of advanced care directives in residential aged care and strategies to improve the
overall provision of palliative care in residential aged care settings. The report will thus help
to increase overall understanding of contemporary issues associated with aged care and
appropriate strategies to improve the quality of healthcare service delivery in aged care.
Palliative care in Australia
With the aging population in Australia, an increasing proportion of people are older
than 75 years and there has been an increase in chronic and incurable diseases ((AIHW,
2018). Thus the need for palliative care for elderly patients has increased (AIHW, 2018). In

2015 to 2016 more than 73,900 hospitalisations in Australia were for palliative care services
(AIHW, 2018). Palliative care service delivery must adapt to the increasing needs.
The Australian population receive palliative care services on the basis of need and not
on the prognosis (AIHW, 2018). In Australia there are almost 1.1 million cases of cancer
related hospitalizations during the tenure of 2016 to 2017. Of them 3.4% (36133) of the
patients were admitted to the palliative care unit. In other words it can be said that palliative
care services are mainly dominated by cancer patients, with 30.7% of pancreatic cancer
patients, 27.4% of lung cancer patients and 20.8% of brain cancer patients. The reasons for
fast deterioration among the cancer patients and they admission to the palliative unit is stroke
(4.2%) and sepsis (3.7%).
Considerable effort has been made to ensure that Australians with life-limiting
illnesses are provided the level of care they need. The lowest intensity of palliative care that
can be provided in any settings is delivered by secondary health care provider after being
referred by primary health care providers. After this, specialist palliative care services are
divided into three categories: resource level 1 is low-intensity care that can be provided with
limited resources at home like relief from pain through pharmacological or non-
pharmacological interventions along with social, emotional and cultural support. Level 2
specialised care is medium intensity and is of higher intensity than level 1 and generally
offered in metropolitan and regional centres; and level 3 is otherwise called high-intensity
care. It is advanced in comparison to level 1 and level 2 (Palliative Care Australia, 2018). It is
usually provided in large regional centres like providing external supply of oxygen, nutrition
through naso-gastric tube and monitoring of the vital parameters with the help of pulse
oxymetry. It requires advanced setup. Primary healthcare providers (mostly general
practitioners) have authority to refer patients to all the three levels of palliative care
depending on the client’s needs (Palliative Care Australia, 2018).

Palliative care in residential care settings
Most older adults who are terminally ill or have chronic illness live in residential aged
care. Thus palliative care in residential aged care settings holds great potential to meet
increasing needs. This is mainly provided by primary healthcare providers such as general
practitioners and registered nurses. Primary healthcare providers who deliver palliative care
in residential aged care services are regulated under the Aged care Act of 1997 and governed
by the Quality of Care Principles (AIHW, 2018). Under the schedule of specified care and
services an Approved Provider of residential aged care services is mainly responsible for
giving access to a palliative care team and subsequent establishment of a palliative care
program. This program deals with monitoring the effectiveness and managing side effects of
palliative care treatments in residential aged care residents while ensuring comfort and
dignity (AIHW, 2018).
Types of palliative care in residential aged care settings
According to the Guidelines for a Palliative Approach in Residential Aged Care
(2004), there are three forms of palliative care that can be delivered in residential aged care
settings in Australia. The first is called the palliative approach. It is appropriate when the
condition of the resident is not amenable to cure and the disease symptoms demand effective
management of the symptoms. The main goal of palliative care approach is to improve the
level of comfort of the resident along with functioning in order to satisfy their psychological,
spiritual and social needs (Australian Government Department of Health, 2009).
The second type of palliative care services provided residential aged care setting is
known as specialised palliative service provision. This involves referral to a specialised
palliative care team or specialised healthcare practitioner. However, it cannot be regarded as