Evaluation of Palliative Care in Residential Aged Care

This document discusses the evaluation of palliative care in residential aged care, including its impact on the quality of life. It also explores the legal and ethical considerations of advanced care directives in aged care and provides strategies to improve the provision of palliative care in RACs.

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Palliative care
student
5/25/2019

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Table of Contents
Evaluation of the palliative care in the residential aged care.......................................................................2
Advanced care directives in residential aged care....................................................................................3
Legal and ethical consideration of ACD in residential aged care............................................................5
Legal issues.........................................................................................................................................5
Ethical issues.......................................................................................................................................6
Strategies to improve the provision of palliative care in RACs...............................................................8
Cultural humanity................................................................................................................................8
Education and provision for the professions, aged person and their family.........................................8
Developing palliative approach policy................................................................................................9
Palliative care service delivery model...............................................................................................10
Conclusion.................................................................................................................................................11
References.................................................................................................................................................12

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Evaluation of palliative care in the residential aged care
Palliative care is the strategy that improves the superiority of the life of the diseased
person and their relatives experiencing the problems linked to the life-frightening diseases, by
the avoidances and release of patient’s suffering by the means of initial identifications and
faultless valuation and management of pain and other, physical, psychological and spiritual
issues (Dumanovsky, et al., 2016). This particular care is provided by the specialized nurse and
physicians and other experts who work collaboratively with the patients and other clinicians to
deliver an additional layer of upkeep. It is well appropriate to provide at any stage of life and can
be provided with any other type of curative treatment. It can be provided in the type of disorder
and at any stage. The palliative care teams are specialized in managing the people suffering
from symptoms and distress of serious diseases like cancer, COHF, COPD, kidney disorders,
Alzheimer’s , and ALS ( Kelley, & Morrison, 2015). The palliative type of care provides relief
from pain, depression, breathing issues, weakness, constipation, vomiting, loss of appetite,
sleeplessness, anxiety and other type of symptoms that might be causing distress. Palliative care
affirms life and respects dying as usual process. It incorporates the mental and spiritual facets of
patient upkeep which offers a provisioning system to help the patient live as healthy as
imaginable till death. It also offers provision system to deal with the requirements of the diseased
person and their relatives to cope with the situations throughout the patient's disease and in their
own grief. It helps in improving the communication between the diseased person and health care
providers (Dumanovsky et al., 2016).
Palliative care can also be beneficial in aged care to provide them wend of life care and
enhance their quality of life. It has been identified that the chronically sick, aging populace is

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increasing; it has been identified that the populations of people over the age of eighty-five will
reach nine million by 2030. These people will require a continuum of upkeep that involves the
end stages of terminal illness (Broad, et al., 2015). It is estimated that nearly 23 per cent of
people dies at their home; approximately 24 per cent expired in nursing homes. In the year of
1989, just 1 per cent people died at their home and nearly 18 per cent spent their end of life days
at a nursing home. With nearly half (47 per cent) of the people with the terminal sickness dying
at house or in the nursing homes currently, therefore there is a growing requirement of palliative
care in these health care settings. There is an increased number of hospitals nursing homes
adopting this approach in order to provide optimum care to the older patient and they show a
high number of positive results. Palliative actually improves the coordination’s of care with the
health care workers and the other team members to make plans for older people at nursing
homes, hospitals, and at their own home (Fitch, Fliedner, & O’Connor, 2015).
ACD in residential-aged-care
Advanced care directives (ACD) are the lawful form or consent that permits individuals
over the age of eighteen years to note their desired wishes, choices and directions for their future
wellbeing carefulness, end of life, all the living provisions, and individual troubles. ACD also
allows them to employ one or additional supernumerary decision-makers to sort these choices in
their behalf what they are not capable to do themselves (Street, Ottmann, Johnstone, Considine,
& Livingston, 2015). It is an essential step forward to plan the future health upkeep, favoured
living arrangements and other separate matter. It basically replaces the present continuing
powers of protection, clinical attorney powers and the anticipatory directions with the lone
advanced care directives form. it help the patient to have peace of mind that the people care for
the patient will know that what they actually want when they are unable to make their individual

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selections or communicate their wishes and values with health care providers and their families
(Stokoe, Hullick, Higgins, Hewitt, Armitage, & O'Dea, 2016).
Advance care directives can be used in a different health care setting as the form to allow
the individuals to discuss their actual wishes and desires related to the treatment, values and
other things. The ACD used to enable the competent adults to provide directions about their
upcoming health care, housing and accommodation preparation and individual affairs. It is also
used to make sure that the instructions wishes and values of the individual who has provided an
ACD are recognised in dealing with the individual’ residential and housing preparation and
personal matters (Dumanovsky et al., 2016). It also aims to protect health practitioners and other
providing effects to the instruction, wishes and values of the individual who has been provided
with an ACD. The advance care directives only used if the person is not capable of making a
decision and if they do not understand the information related to the choices if they cannot
understand and appreciate the risk and advantages of the decision. ACD also take place of the
individual is not able to recall the info for a short time period, and cannot tell anyone what the
choice is and when they have made the choice (Leong, & Crawford, 2018).
An advance care directive is also effective in residential aged care. Elder people are
unable to make decisions as the decision-making ability is reduced. It has been identified that
most of the elder people have clear preferences related to their end of life care, but due to the
lack of accepting of ACD in residential aged care, hospital and residential care services (RACFs)
are commonly the least favoured places to die (Kelley, & Morrison, 2015). ACD provides a way
for aged people to design ahead for the time when they will lose their capacity of choice making.
To implement ACD in residential aged care systems needs to make sure that routine review of
the ACD and proper transfer of the data between eh health care workers must be implemented by

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the doctors and nurses. Regular education about the ACD is provided to the aged care providers,
residents, and families and the general practitioners (Stokoe et al., 2016).
Legal and ethical consideration of ACD in residential aged care
Legal issues
The most usual legal article was an EPA (Enduring Power of Attorney) and the Power of
Attorney (PA), which together tell to the decision related to the finances and property. Majority
of the cases of ACD in residual aged care do not contain a copy of this document, hence it was
unclear where power of attorney document is a continuing power or not. This placed a question
related to the legality of the employed decision maker (Detering, & Silveira, 2017). Some of the
legislation implemented I Australia for Advanced care directives include power or attorney act
1998, the medical treatment act 1988, the advance care directives 2013, the guardianship and
administration act 1990, the advance personal planning act 2013, and the medical treatment
(health directions) act 2006. In most of the authorities, the legislation permits the ACD to
involve consent to or denial of health care, comprising suppression or withdrawing life-
supporting treatment. In Victoria, the denial must relate to the current condition. In the South
Australia the decree status that delivery in an Advanced care directive including denial or
specific health care is the compulsory provision, however, all other requirements are non-binding
(McGlade, Daly, McCarthy, Cornally, Weathers, O’Caoimh, & Molloy, 2017). It is a legal
requirement that all the residential aged care services establish and apply a inclusive palliative
care program. It also enables the health care service providers that a modest, practical tool or
method for the advance care planning to be established in agreement with the Authorization
standards and proper. The legislation associated with advanced care directive in the residential
aged care imposes a legal requirement that a multidisciplinary case consultation should be

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introduced to converse and manuscript the residence wellbeing care design within some weeks of
admittance to a service. Thus comprise advance-care-directives (ACD) recognised on the novel
tools to make sure that the desires of the aged person are encountered (Galambos, Starr, Rantz, &
Petroski, 2016). The public education should be enhanced to increase the public consciousness of
the particularly advanced directive legislature at every state, notifying individuals related to the
legislation involves any misunderstanding related to the extent of the continuing power of
attorney. In all the jurisdictions there are some necessities that apply to the implementation of
advance care directives. In every jurisdiction in Australia except Queensland and ACT, the
advanced care directive should be in the approved form. In every jurisdiction, it should be
witnessed with single or more individuals. In certain jurisdictions, the witnesses of ACD in RAC
(residential aged care) must certify their satisfaction of some matters, and a physician should also
certify some specific matters. The witness and the physician are needed to certify that the values
have the potential to make the Advance wellbeing directive in residential elderly care. It is the
legal right of the person to deny a specific treatment, if the aged person refused to a particular
treatment, the witness and the physician are obligatory to certify some ammeters for the denial of
treatment certificate involving that the elder patient is of sound mind (Crispin, Bestic, &
Leditshke, 2015).
Ethical issues
While providing ACD in the residential aged care there might be some ethical issues that must be
resolved. Advanced care directives are based on respect for the individuals' autonomy and are
patient focused. The ethical issues arise when the individual is not as respected as the expected in
residential aged care (McGlade et al., 2017). The legislation allows the older people to make
decisions about their treatment and health care facilities, but it happens sometimes that the older

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individuals deny a treatment that is most effective for him and health care continuously advise
him to have that treatment. Older people are autonomous and the autonomy can be applied in
dissimilar manners according to the individuals’ culture, race, history and background or the
spiritual and sacred beliefs (Gilbert, & Boag, 2018). In the absence of main decision maker
assigned for the individuals, substitute decision makers are provided for them, ethical issues
might take place when the substitute decision maker is not having that much of experience and
skills. The substitute decision makes must respect enduring decision-making ability. The
principle choice making must only base their decision on the finest interest in lack of evidence of
the individual's first choice on which to base the substitute decision. An individual or their
lawfully recognised substitute choice maker, can only consent to the treatment offered, deny
treatment provided, but cannot demand treatment (Clayton, Luckett, & Detering, 2018). The
ethical issues may arise when the ACD process has been hurried or seen as the tick box practice
by the health care providers, and if any unforeseen events in the otherwise expectable disorder
course arise. If the health care professional or decision maker do not possess the essential skills
to assist the aged persons to clearly eloquent their opinions. The wording of the advanced care
plan mist finest reflect the opinions and values of an individual. However, the wording of the
ACD plan might not continuously accurately reflect that aged people views or opinions. These
particular issues might arise even when the ACD planning is completed conscientiously as the
future is uncertain (Crispin, Bestic, & Leditshke, 2015). However, it can be worsened where the
ACD planning process has been hurried or seen as the tick box practice by the health providers
or decision makers. The timing and the context of the advance care directives and planning and
the development can have some important impact on is usefulness both o the aged person in
residential aged care and the health care providers. An individual might possess the legally

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competent to make their choices but their decision or capability to comprehend complex health
info might have been continuously compromised by the events at the time an ADC was
developed. For instance, an older individual is needed at short notice to progress a strategy
before the aged care service will accept them as a resident, or where a diseased person progress a
plan at the time of severe distress or stress, after being identified with the severe disease
(Detering, & Silveira, 2017).
Strategies to progress the provision of palliative care in RACs
Cultural humanity
Cultural humanity is the approach that can resolve the issues related to autonomy. Adopting this
strategy may work best in delivering advance care directives and planning (Sussman, et al.,
2017). This particular approach includes avoiding making assumptions about patient’s culture,
asking the aged person about how they may like to made their decisions if they are not able to
perform so themselves, and asking the aged individual and his or her family who they want to
involve in their decision making the process. Avoiding assumption permits health care providers
to approach the ADC or planning conversations in the finest way. Patient’s preferred language
must be considered which can be done by using the interpreters when suitable in ADC planning
discussion (Burke, Wight, & Chenoweth, 2018).
Education and provision for the professions, aged person and their family
Educating health professionals, aged person and their families are important to deliver palliative
care successfully and efficiently. An educated, skilled and qualified health professional is
essential in delivering palliative care to the aged individuals in residential elderly care. Education
should be provided in the early training process and continue as part of professional development

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(Frey, Boyd, Foster, Robinson, & Gott, 2016). The value places in the learning and training in a
residential aged care facility can send a robust message to the health providers’ show how truly it
views initiatives of education and training. To enhance the skills among the substitute decision
makers, education and training must be provided to them. Education provided to the family and
aged people may help in the successful delivery of palliative care in residential elderly or aged
care, and allow them to male wishes and decisions more easily. A whole-of-facility strategy can
be used for staff education, training related to implementing the palliative strategy (Karacsony,
Chang, Johnson, Good, & Edenborough, 2018). The learning, training and proficient
development in the palliative care approach must not be restricted to the medical and health care
staff. Another approach called a Program of Experience in the Palliative Approach or PEPA can
be implemented to provide proper education and training which offer medical placements in the
specialised palliative care facility (society and inpatient) and tailored workshops to wellbeing
professional form a verity of disciplines. This particular approach or program is freely provided
by the Australian government. Proper education can provide information about what ADC is, its
benefits, and what included in the process, counting that it can be revised, and what substitute
decision makers is and how they work in the palliative care. It also provides information to the
patient and their family that how important consent form and other documents are (Crispin,
Bestic, & Leditshke, 2015).
Developing a palliative approach policy
Policies and process are planned to guide and determine all the main decision and activities and
to make sure that every practice takes place inside the limits set by the policy developers. Policy
and procedure make sure that the organisational governance of the association’s viewpoint is
interpreted into the stages that outcomes in a result attuned with that view (Butler, 2017). In that

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policy some of the points should be included, that is done the residential aged care facility have
the palliative care policy, does the particular policy needs amending or modernizing, is there an
recognized timeframe for the strategy review and information of who will commence this
analysis, and does that residential aged care facility needs particular policy documents. The
palliative care policy must include certification of the RACF idea for the palliative care in the
strong and brief policy, significant definitions, and a record of the bases of evidence applied in
the strategy, and the list of key processes linked with the routine actioning of the policy
(Detering, et al., 2019).
Palliative care service delivery model
Advance care planning backings and endorses the notion of patient autonomy and the patient-
focused decision-making model. The palliative care service delivery model can be used to reduce
the issues arise during the process of palliative care delivery in a residential aged care facility. It
can provide the framework or outline for the palliative care faculty providers to function
collaboratively of the welfares of the patient and their relatives in the provision of the superior
palliative care facility integration (Silver, et al., 2015). The particular model identifies that
patient suffering from a life-limiting disease needs dissimilar levels of involvement of palliative
care centred on the requirements and the capacity of health care providers and substitute decision
makers. This particular model set the criteria and liability of health care providers to have a
consent form from the patient or their families. It also assesses the needs of the patient and takes
accountability for coordinating the fulfilment of those requirements. It delivers the services and
advice to the substitute decision maker and other health care providers and provides bereavement
support (El Osta et al., 2015).

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Conclusion
Palliative care is recognised as the health care method that progresses the high superiority of the
life of a patient, through avoiding and reducing patient suffering by initial identification and
assessments. Advanced care directives are the legal form or consent that allows the individuals to
record their wishes, decisions, and other matter. ADC can be effective in identifying the issues,
needs, and make a decision in residential aged care if the patient is unable to make a decision on
their own. There some legal and ethical issues may arise while delivering ADC in residential
aged care such as issues related to substitute decision makers, consent forms, patient autonomy
and belief and values of the older people. There some strategies can be used to enhance the
delivery of palliative upkeep in residential aged care. Cultural humanity approach can be
integrated to resolve issues such as patient autonomy, providing education to the health care
providers, patient and their family. A palliative approach policy and palliative care service
delivery model can be implemented to reduce issues of consent, beneficence and substitute
decision makers.

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