Palliative Care in Residential Aged Care: Improving End-of-Life Stage for Aging Australians

This article discusses the provision of aged care through palliative care and advanced care planning in residential aged care. It explores the evaluation of palliative care, the role of medical practitioners, and the legal and ethical issues associated with advanced care directives. The article also highlights the need for better policies to improve the provision of palliative care in residential aged care.

Running head: PALLIATIVE CARE 1
Health and Social-Political Issues in Aged Care
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Introduction
As the population of Australia ages, there is a need to improve and embarrass on the
residential aged care. Residential Aged Care is appropriately designed and equipped facilities
which enable the medical practitioners to access patients in order to provide healthcare services
specifically needed by the old people. Today, not less than 200, 0000 Australians reside in the
over 2,000 residential aged care daily (Ralph2018). Over 50% of the residents living in this
residential aged care suffer from dementia. Sequentially research shows improved quality of life
for the victims involved with an environment that engages them with a variety of activities.
Residential aged care, through the palliative care approach, provides a promising way to improve
the end of life stage for the aging Australian population. As people near their end of life age,
their decision-making capacity reduces. To solve this, a policy on advanced care directives was
developed to provide patients preferences as well as palliative care. The essay will hence focus
on the provision of aged care through palliative care and also discuss on advanced care planning.
Evaluation of palliative care in residential aged care
A range of care options is available for elder people in the country who may find it hard
to continue living independently in their homes. This care includes 24 hr basis personal care to
assist with daily leaving needs. Palliative care in aged care is an approach that tries to maximize
the quality of life of a patient with life-limiting illnesses by reducing their suffering. This is
through early diagnostic, valuation and medication of pain, psychological, or spiritual needs.
Palliative care believes medication should not be based on physiological medication alone.
Residential Aged Care has staff nurses with diverse skills to provide palliative care needs to the
residents. The nurses provide care, comfort and in a familiar home-like environment. This

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ensures the older Australian receive the best experience they would have wished to live during
their end of life stage (Bruera, 2012).
Medical practitioners play a major role in Palliative care by prescribing medical
treatments and directing care to patients with life-limiting illnesses. Life-limiting illnesses can be
defined as illnesses that sensibly expected to cause death to the patient anytime within the
foreseen future. Palliative care teams in the aged care facilities are dedicated in trading people
suffering from a serious ailment such as cancer, pulmonary diseases (COPD), congestive heart
failure, kidney diseases, mental diseases such as Dementia, Alzheimer's and many others. The
approach of treatment care treats pain, fatigue, shortness of breath, nausea constipation, difficulty
sleeping, depression, anxiety, and any other symptoms causing distress. This will help to
improve both the life of the patient and that of the family.
The palliative approach in residential care is provided following set quid lines. It requires
the healthcare provider to openly engage the patient together with their loved ones and family
members into an open dialogue in order to get their consent. Palliative care provides the patient
with; autonomy which is self-respect, honesty and comfort, provide an open discussion on the
nature of treatment options and give patients a choice on available treatments options. The care
also provides effectiveness in pain management and improvement on quality life as defined by
the cultural, spiritual preference of the patient. Palliative approach affirms to life immortality and
respects death as a natural process. It honors how the patient would like to spend his end -of -
days-life.
A critical discussion of advanced care directives in residential aged care
Planning and communication aid greatly when it comes to the end of life decision
making. Advanced care planning is the process of making the decision on about the care you

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would wish to have when it comes to the end of life stage. The goal is to maximize the
preferences and self-rule in this the critical stage of life when the patients are not in the capacity
to make decisions independently. A person makes his medical preferences solely, then after
which the person can discuss these decisions together with their loved one, family members and
professional healthcare providers to get their views. The final decisions are then documented in
the document which is so-called the advanced care directives. Advanced care directive can hence
be defined as a written statement of the type of medical treatment the patient would which to
have at the end of life.
Advanced care directives confirm and communicate patient wishes to the healthcare
professional (Crispin, 2015) in the time where the patient is not in the capacity to make the
wishes. These decisions are not awaited to be made in the ICU bed but are made long before the
time of implementation comes in the living coach together with family members. As a patient,
one has the power to draft how your end of the life stage you would like to be. The decision may
not be an essay but when drafted together and in the sober times in collaboration with family
members and professionals, it becomes quite easy and necessary. In advanced care, plans enable
the patient to air their views in the future in preference to treatment option at the end of their life
when they will not be in the decision-making capacity. Advanced care plans provide the means
in which the patient and family preferences are honoured before the patient is undertaken
through any disease treatment or in making a decision. In short, ACD promotes patient autonomy
Why are they used?
Patient in the end stage life may be deprived of the judgmental capacity to make a
rational decision or communicate their wishes on how they would like their medication
conducted. ACD will hence be used to provide an opportunity to deliberate existential and

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relational features on approaching loss of self at end of life. According to Quest (2011),
Advanced Care directives offer substantial benefits to the healthcare providers in enabling them
to solve on uncertainties about what the patient would or would not want in a certain condition.
The directives delegates responsibility. They provide the opportunity for the person to evidently
acknowledge panorama of death and outline on the patient's preferences regarding medical
actions to be undertaken such as the continuation of treatment or resuscitation
How are they used in residential aged care?
Advanced care directives have bulk usage in providing early palliative care in residential
aged care.ACD can be used to negotiate the patient's preferences at the end of life situation
where the patients may not be in the capacity to make the preferences themselves. ACD
communicate to the healthcare provider on whether the patient is willing to continue with life-
sustaining treatments or is willing to undergo resuscitation with treatment that may induce pain
and discomfort or even hasten their death.
According to Lund (2015), benefits of Advance Care Directives in palliative care include
considerate medical care, improved quality of life at the end-of-life, and resolving a conflict that
may arise in decision making on how the care to be provided- this greatly contributes to family
bereavement cooping.
Critical analysis of the legal issues with using advanced care directives in residential aged
care
Since the mid-70s, healthcare directives have been the core tool to ensure patient’s health
care preferences are set up and hopefully followed by the healthcare practitioners. In Australia,
the legislative framework of advanced care directives varies by state and by territory. All states
and territories in the country, except Tasmania and NSW, have statutory Advanced Care

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Directives. Advanced care directives are legal documents that offer a promising future in
determining medical preferences of the resident are upheld.
In Australia, Advanced Care Directives are supported by both statue law (determined by
legislation) and common law (determined by a judge in a court of law). The paper will discuss
legal issues surrounding Advanced Care Directives based on following legal case; On August 6th
2009, Hunter and New England Area Health Service Vs A [2009] NSWSC 761, the supreme
court decision was made. The case is important because it was the first NSW Supreme Court
decision to summarize relevant legal principles governing advanced directive care. Mr. A, who
was a Jehovah Witness follower, had renal failure and was kept alive by kidney dialysis and
mechanical ventilation. However, Mr. A had a healthcare directive indicating he would not wish
any kidney dialysis. After the case was presented in a court of law, the Supreme Court decision
summarized relevant legal principles as follows;
In an exception of emergency cases, it is a universal law not to administer medication to a
person without his or her contest. The contest can be provided through the advanced care
directive which was prepared when the victim was in the capacity to.
The contest may be implied or may be expressed considering the person is an adult and if
not so, the contest is given by legal guardian and the next of kin cannot give the contest on behalf
of the adult. It is supposition an adult is in the capacity to avoid medication; this assumption is
debatable considering the patient's sound mental capacity and if there is need to save the life of
the unborn child.
If there is reasonable doubt if the rationality of the ACD applies in current issue at hand,
the residential age care must seek the court jurisdiction to clear the vague. The healthcare

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provider can then administer the care according to the court's decision in the consent of the
validity of the advanced care directive.
A person anointed as a substitute decision maker has the legal jurisdictions and supported
by Australian statute law to make medical decision on behalf of the patient. If the patient had not
anointed a substitute decision maker, each territory/ state, has legislated hierarchy which defines
who can be called upon to make a medical decision.
Advance care Directives rely on the common law of respect to self-autonomy. Aged Care
facilities should treat Advanced Care Directives with the legal care they deserve. It is a battery
law that a competent adult has the right to refuse certain medication treatment or care.
Critically analyze the ethical issues associated with advanced care directives in
residential aged care
Beneficent actions have traditionally guided the ethics of healthcare provision. It would
be highly unethical to inflict any medication to a patient without his or her contest. Carter (2012)
discusses beneficent as a guiding principle of charity, kindness, and mercy that guides any health
practitioner in doing right or wrong. According to laud (2015), advanced care directives rely on
the concept of self-autonomy which laud defines as “the authority of the former competent self
to govern the welfare of their later, non-competent selves.” Advanced care directives may not
include all the medical preferences of the patient. In that case, a substitute decision maker is
necessary. A substitute decision maker is a person who can be called upon to make a medical
treatment decision on behalf of the patient. Family members, or a public advocate, can choose
one a close relative to be a substitute decision maker who can make a decision on behalf of the
patient.

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Advanced Care Directives are usually eyed as a solution to ethical problems in
accordance with what the patient views either morally right or wrong. Advanced Care Directives
provide guidelines on the kind of medical care the patient would wish or would not wish to
receive. Having treatment or not wishing to have treatment is someone's decision. It becomes
immorally wrong and unethical to impose any medication contrary to the patient's preference.
The patient can indicate how independent his or her decisions are and this creates room for
change and by only then the healthcare profession can alter the kind of care to be provided.
Ethical Critique of advanced care directives
In a journal by BMC medicals by Alonco (2017) 143 patients died during their
hospitalization between 2011 and 2014 out of stroke. Only 30% of the patients, 42 of them, had
successfully carried their advanced care planning and filled the advanced care directives but only
24% which is 35 were available. Out of these, a review on the medical file found out that only 16
out of the available ACD could be applicable in treating the patients. 33/35 which is up to 94%
indicated that medication for the alleviation of pain or discomfort should be used even if the
treatments could fasten or result in death.
On a review by Mamhidir (2007), a major flaw in the effectiveness of the advanced
directives is an attempt to determine the medical procedure without an attempt to focus on the
description of the applicable ACD. Consequently, the available ACD may not always sound
suitable for the scenario in hand. Most of the patients are not informed on Advanced Care
Directives or what is needed of them. The findings necessitate the need for educational programs
to the members of the public for the need for sensible, comprehensive and appropriate advanced
care directives for easier and ethical the end of life decision making.
Strategies that may improve the provision of palliative care in residential aged care-

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Better policies
In Australia, residential aged care is subsidized and regulated by the Commonwealth
government and governed by the Aged Care Act 1997. Ostaszkiewicz (2016), acknowledges
that the residential aged care is one of the heavily regulated sectors in healthcare, more palatable
policies need to be developed that will inflict a kind of freedom to the residential aged care. This
will ensure resident enjoy the stay and the staff members are comfortable in administering
palliative care to the patients.
The National Palliative Care Strategy is committed to ensuring the highest achievable
level of Palliative Care is provided to the Australians’ old residents. According to the Australian
Department of health, $32.8 million for four years, up to 2020-21, was announced as part of the
2018-1019 budget for the comprehensive care in Aged Care measure, the residential aged care
have complained that the amount subsidized by the government is not enough to run the aged
care and in provision of palliative care. To solve this, proper benchmarking can be conducted to
evaluate how much the residential aged care requires adequate policy funding can be provided.
(King 2015) insist More policies that encourage the older Australian to stay at home can also be
developed. This will cut the number of older people at the residential aged care and the funding
can be made to encourage them to stay at home so that topnotch person specific palliative care
can be provided at their homes.
Training
For effective submission of palliative care, the care should be submitted by a team of
highly trained doctors, nurses or any other highly trained healthcare specialist. Palliative care
should also be provided alongside other curative approaches in order to provide promising and
appropriate care at any stage of illness to the patient. This means these healthcare providers need

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extensive training to maximize their provision of palliative care. Connell (2015) acknowledges
that Australia Is faced with workforce problem and High training better training will ensure more
qualified staff is being added to the pool of t health practitioners providing palliative care in the
residential aged care.
The community also requires extensive training. Most of the community members are
blinded by the misconception that palliative care means the end of life and it is for the dying old
people. This misconception needs to be washed from the people's minds. Citizens alongside the
residents of the palliative care need to view the end-of-life of the patient with a positive angle to
help the patient enjoy their end days. Proper community knowledge aids greatly in determining
how palliative care is being provided.
Use of Technology
There is a pool of exiting technological advancement that is being developed and can be
of big help in residential aged care. Every industry is embracing new technology and aged care is
no exemption. Use of modern technology can help ease the burden of care provider deficit in the
tremendous margin.
Elsi Smart Floor
Utilizing similar technology to iPad is the Elsi Smart Floor covering od the aged care
facility, an alarm, and monitoring system made if several tiny pads which are placed on the top
of the flooring. Tanaka et al (2015) discusses the Elsi Smart Floor monitors the client's
movements alongside that of the staff members and it sends relevant data as the floor is being
pressured on. This defiantly improves how care is being provided as the care provider can
closely monitor the behaviour of the resident, and the system can send an alarm immediately in

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case the resident needs help. This ensures no delays in the provision of palliative care in
residential home care.
Paro Therapeutic Robot
This is essentially a robotic machine that consists of a number of socializing and stress
management in the patients. The Paro Robot mimics animal behaviour with its sense of posture,
temperature, audio, light, or tactile recognized by touch. This causes the machine to react in a
certain way inflicting a positive reinforcement needed by the patient. For example, if you like the
yelling voice it makes, you just need to strike it gently. Many researchers have proved the
positive socializing effect animals have with the elderly and with stress/socializing effect.
Aminuddin (2016) is happy on how the innovation has been fruitful in controlling physiological
stress in older patients and this can be of great help in the promotion provision of palliative care.
A critique is that some of the residential aged care may be naïve to embrace some of the
modern technological advancement. Consecutively not every Aged care provider or professional
care may be aware of the new technological advancements or will be in the position to embrace
and use them. If you are a healthcare provider embracing the new technology then you curve
ahead of others and be better professional care compared to others. This will automatically
improve the way palliative care, and other models of care, are being provided in the residential
aged care sector.
Conclusion
According to the Australian health statistics, the necessity of Residential Age Care is
ever increasing in Australia. It is important to give the old people high quality supported
healthcare in their end of life stage whether they are in residential aged care, acute care hospital,
dedicated hospice service or even in their homes palliative care approach is one of the effective

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approach aimed to improve the quality of life both to the patients family members. Improved
technology, better policies and increased training both to the staff members and to the
community as one of the ways to improve on palliative care being provided. Use of advanced
care directives of high palliative care in aged care facilities enables older Australians to have
good health and get better support from their family during the end of life and bereavement
process.

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