Palliative Care in Residential Aged Care: Impact of Advanced Care Directives

Running head: PALLIATIVE CARE
Palliative care
Name of the student:
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Author’s note

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Introduction:
Palliative care is an approach to care that provides support to patients and families
with life threatening illness and offers a support system that reduces suffering and improves
the quality of life of such patients (Pal & Manning, 2014). With the increase in life
expectancy and the increase in ageing population, more number of elderly people is in need
of palliative care because of chronic multi-morbidity, frailty, functional dependence and
cognitive decline. Such trend has increased the demand for palliative care services that is
tailored to the needs and situations of the elderly and very elderly patients. As large number
of elderly people is now residing in residential care homes, the analysis of palliative care
services in RACs is necessary (Voumard et al., 2018). This essays aims to explore the
provision of palliative in residential aged care and critically evaluate the impact of advanced
care directives (ACD) in residential aged care (RAC). The essay will further look at legal and
ethical considerations associated with ACD and analyze strategies that may improve the
provision of palliative care in RAC.
Evaluation of palliative care in residential aged care:
The main purpose of palliative care services is to enhance the quality of life of people
with serious and life limiting illness and focus on providing aggressive symptom
management and psychosocial support to reduce sufferings for patients. It plays a role in the
alleviation of physical, psychosocial and spiritual symptoms of patient. Palliative care
specialists and other staffs working in palliative care services work to deliver appropriate
medical care and align patient’s preferences and needs with those of other team (Rome et al.,
2011). With the increase in ageing population, palliative care has been introduced in many
settings such as RACs, general community services and hospitals. The advantage of a
palliative care service in RACs is that they help to identify those patients who are in need of

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palliative care through Aged Care Funding Instrument (ACFI) assessment (Butler, 2017). The
key advantage of palliative care in RAC is that it gives elderly people the opportunity to
receive appropriate medical care from the comforts of their home. By reducing the need for
prolonged hospital stay, such palliative care services provide personalized care environment
to patients and reduce feelings of neglect, isolation and poor social support (Kong, Fang &
Lou, 2017).
As the number of RAC resident has increased, the decision regarding hospitalization
and end of life care has become more challenging for such residents. With the increase in
ageing population in Australia, the proportion of RAC resident has increased (Naccarella et
al., 2018). Although the provision of palliative care in RACs provide the benefit of reduced
hospital admissions and more symptom control, however some of the complex decision in
palliative care given in such facilities relates to hospital transfer decisions. Such challenges
emerge because of presence of disorders like dementia, advanced care directives and the
harms of hospitalization such as further deterioration of symptoms, pressure sores and
inconsistent care (Leong & Crawford, 2018). The report by Australian Institute of Health and
Welfare (2016) also justifies that RACs face challenges in administering palliative in patients
with co-morbidities and communication difficulties or dementia. For RAC residents,
separation from such facilities occurs in situations of death, admission to hospitals, returning
back to the community and other reasons. Future research needs to explore the manner in
which such decisions can be simplified and optimize safety for elderly patients.
Despite several issues associated with delivery of palliative care in RACs, the
popularity of the service cannot be ignored because of the role of such service in optimizing
quality of life for patients. Currently, minimizing hospitalization rate for elderly people in
RAC has become a focus of health care policy too. The care coordination between the nurse
practitioner and the multiprofessional health care team plays a role in providing better quality

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of life to residents. However, no change in rates of emergency department transfer has been
seen. The positive aspects coming out from such data is that the length of stays in hospital is
reduced for RAC residents receiving palliative care (Frey et al., 2018).
Critical discussion of advanced directives in residential aged care:
For patients receiving palliative care, one of the major challenges is faced for patients
who suffer from advanced level of disease such as cancer and those who are at the end of life
stage. Many time conflicts take place because a disconnection is found between end of life
care patients care preferences and what actually happens in practice (Ranganathan,
Gunnarsson & Casarett, 2014). To minimize such issues, the concept of advanced care
planning has emerged which allows people to plan ahead for their care preferences in case of
loss of decision making capacity in the future. This plays a role in respecting patient’s
preference as well as providing autonomy to patients during their care decision making
(Leditshke, Crispin & Bestic, 2015). During advanced care planning discussion, end of life
patients get the opportunity to share their cultural values, beliefs and care preferences to
guide future decision making. With regard to such planning, advanced care directive (ACD)
is prepared for individual patient, which is a special type of document where the advanced
care plan is expressed in writing and this is signed by competent adults and recognized by
common legislation (Ranganathan, Gunnarsson & Casarett, 2014). The prevalence of
advanced care planning among older people in RAC in Australia is high because of presence
of several legislation supporting the cause of patient autonomy. Such planning is particularly
important for elderly people as they are more likely to suffer from conditions impairing their
decision making capability (Street et al., 2015).
The main goal of advanced care planning and ACDs are to align the actual care
delivered to patient according to their preferences. Successful completion of ACDs supports