Socio-Political Issues in Aged Care

This document discusses the socio-political issues in aged care, focusing on the need for urgent reforms in the Australian healthcare system. It explores the provision of palliative care in residential aged care, the use of advanced care directives, and the legal and ethical considerations associated with residential aged care. Strategies to improve the provision of palliative care in aged care are also discussed.

SOCIO-POLITICAL ISSUES IN AGED CARE
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1. Introduction
Australia has one of the largest proportion of aged people. With such statistics, the
country’s system of aged care is also well organized. Acquisition of aged care skills is, therefore,
one of the most important skills required by healthcare professionals within the Australian
setting. As individuals age, their medical needs are likely to increase. The Australian aged care
industry offers a wide range of health services to the aged population allowing them access to
necessary care levels where and when required as they age. With the rising demands, there has
been a lack of political will to institute the necessary reforms within the Australian healthcare
system. A report released in 2017 showed that about 100,000 older people had been lining up for
government-subsidized healthcare packages done (Armstrong & Collins,2017). The number of
individuals waiting for government subsided home care packed has been rising significantly.
Home care waiting time is among the challenges facing the Australian aged care system.
Commendations for improvement have been made in recent time but not much has been done
(Armstrong & Collins,2017). The Australian palliative care in aged care needs urgent reforms for
improved outcomes of the aged population
2. Evaluation of Palliative aged care in residential aged care
What palliative care is
Palliative care refers to the specialized medical care for persons with life-threatening
illnesses. The focus of palliative care is improving the quality of care for patients together with
their families. This is done through early identification and prevention of suffering from stress
and symptoms associated with serious illnesses. Palliative care also entails flawless assessment
and treatment of issues associated with life-threatening illnesses. In other words, palliative care
offers relief from distressing symptoms and pain associated with serious illnesses. Secondly, it

either speeds up or delays death. Thirdly, it incorporates spiritual and psychological aspects of
care.Fourthly. it provides patients with the necessary support to enable them to live an active life
until the time of their death. In addition, palliative care is meant to offer the necessary support to
families to help them cope during the time of illness and bereavement. Finally, palliative care
sustains life and enables the affected to look at death as a normal process (WHO, 2019).
Conclusively; palliative care has a goal of improving the quality of life for both the family and
patients
Provision of palliative care in residential aged care
As the Australian aging population rises, so has the number of the individual; being
admitted to residential aged facilities. For such individuals, this is usually their last home.
Palliative care in aged residential care is provided by palliative care nurses who are specially
trained to take care of patients with life-threatening illnesses together with their families
(Caresearch, 2017). Usually, these are individuals with many years’ experience in palliative care
equipped with high-level skills through training and experience. Palliative care nurse work in
various settings including acute in-patient facilities, clinics, residential hospices and patient’s
homes (Schroeder & Lorenz,2018).
Provision of palliative care
Palliative care nurses may work in collaboration with a team of specially trained nurses,
doctors and other specialists to offer extra support. Collaboratively, this team treats people stress
and serious illness symptoms such as anxiety, sleeping difficulties, loss of appetite, nausea,
constipation, fatigue, and shortness of breath, depression, and pain to improve patient’s quality
of life(Center to Advance Palliative Care, 2019).

This is done through communication with the patient. The team spends time talking and
listening to patients to ensure that patients understand their treatment choices and options.
Through this aspect, the team helps a patient to choose treatment options that match their
personal goals. The palliative care nurse in collaboration with other specialists also ensures that
the patient's doctors are coordinated and understand what the patient wants. Generally, this is
meant to facilitate improved quality of care and ensure that patients have control over their care
(Center to Advance Palliative Care, 2019).
What supports do they have to access to?
Palliative care nurses need to have access to support from other nurses, doctors, and other
specialists. Generally, these are required to provide an extra layer of support needed for
improved outcomes (Champion, 2017).
How effectively is palliative care is provided?
Although there are well-established care programs in Australia, the programs are not
being used effectively. For example, palliative care referrals are often delayed yet they are
supposed to be done early in the onset of a terminal illness. Patients may also sometimes decline
referrals for various reasons. The doctor may also delay palliative care referrals. Commonly also,
palliative care may reduce hope and cause distress among patients and their families. In addition,
a departure from the treatment of a serious illness to an attempt to make a patient more
comfortable may paper like an abandonment of the patient by the doctor. Unlike palliative care is
provide early, it may expose a patient to additional discomfort and futile treatment
(Maddocks,2016).
2. A critical discussion of advanced care directives in residential aged care
What they are

Advanced care directives are legal forms in which people aged above 18 years put down
their instructions, preferences, and wishes for future personal matters, living arrangements, end
of life and healthcare. Care directives also allow people to appoint assistant decision makers in
the event that they are not able to make decisions on their own in the future
(Advancecaredirectives, 2019).
Why they are important
Informed consent is an important consideration in healthcare. This means that patients
have the right to have control over their medical treatment in as long as they are able to do so
mentally. Informed consent allows patients to choose their preferred course of treatment from
those offered by a doctor. For palliative care patients, this may entail the choice of preferred
treatment option from choices such as comfort care, aggressive treatment or none. In achieving
informed consent, the nurse or doctor has the responsibility of explaining to a patient the
available alternatives as well as the associated risks and benefits of treatment options before they
arrive at a decision. In this case, treatment can only be given if the patient agrees to it.
Generally, it is acceptable that an adult may refuse medical treatment or testing if they are well
informed about the impacts of refusing (The American Cancer Society medical and editorial
content team, 2016).
Advance directives are therefore important because they allow patients to consent to
situations where they may want or not want treatment in the future. It allows them to appoint
individuals who can make consent decisions on their behalf to ensure that their wishes are
adhered to even in circumstances where they cannot talk to doctors (The American Cancer
Society medical and editorial content team, 2016).
How they are used in aged residential care

Advance care directives are used in aged residential care to give aging patients an
opportunity to make decisions regarding their preferred course of treatment or choose an
individual to make decisions on their behalf in case they are unable to. Advance care directives
are an important part of care planning. In aged patients with chronic illnesses, advance care
directives are made part of routine care just in case such patients need to advance to residential
care (Crispin, Bestic & Leditshke,2015).
4. Legal and ethical considerations associated with residential aged care
Legal issues
Advance care directives are based on the respect for the right of a patient to decide how
decisions pertaining to their care are made. It recognizes that each person has healthcare
preferences, which should not be ignored in the provision of care. Both common and statute laws
support advance care directives. All Australian Territories and States except Tasmania and NSW
have statutory advance care directives. Legally, advance care directive document may include
refusal of treatments for either a particular treatment or all treatments under specific conditions
or all conditions (Advance Care Planning, 2019).
However, advance care directives are only possible when an individual has decision-
making capacity or is competent. Without meeting these requirements, an individual is
considered incapable of making informed decisions. For individuals to be considered competent,
therefore, they must have the ability to express a choice, weigh associated benefits/risks, and
appreciate the relevance of the information to their current situation and have the ability to
decipher information (Advance Care Planning, 2019).
Generally, the law recognizes that individuals in residential aged care have the right to
control any decisions relating to their care. It also recognizes that the right to make decisions

regarding the appropriate course of care may be done by a representative chosen by the patient.
These provisions are based on an individual's rights to the consent or failing to consent to a
course of treatment depending on their wishes. The recognition of the consent a patient to decline
or accept a medical intervention after they have been furnished with the necessary information
on risk and benefits is one of the means of recognizing the autonomy of patients. However, in
residential aged care, patients may be unconscious or be under so much distress that they are not
able to communicate their wishes in situations where treatment decisions are required.In such
situations where the patient is unconscious or faced with so much distress, the application of
informed consent legal requirement may be limited (ASPE,2019). In a situation like a sudden
stroke, a patient may not have the opportunity to give their consent on the preferred course of
treatment.in such occurrences, the individual might not be in full control of their faculties. As
such, the legal requirements of informed consent and the preferred course of treatment may not
be met (ASPE, 2019).
Ethical issues
Ethics is a fundamental aspect of residential aged care. An ethical framework offers
healthcare providers guidelines for choosing what is right to do in the course of their work. In the
same way, care providers are faced with the dilemma of choosing the most appropriate
interventions for their patients. Acting in accordance with the wishes of the aging persons is an
important aspect of aged care. The personnel involved in the provision of residential aged care
face multiple ethical issues. Reasonably, this is because residential care is complicated by the
multiple complex social and medical problems of the aging persons. Some of these issues appear
in unfamiliar ways while others are unique to some settings. Some of the issues that they have to
deal with include decision-making capacity, competence, and advance directives.

The principle of autonomy requires patients to have autonomy of action, intention and
thought in the process of making decisions pertaining to their care. The process of making
decisions must, therefore, be free from coaxing or cohesion. Secondly, patients must be aware of
the likelihood of success and understand all the benefits and risks involved (Niemeijer et al.,
2010) sometimes, however; the decisions made by patients may not be those that lead to
optimum outcomes for patients. The residential care team may, therefore, be faced with the
dilemma of choosing the most optimal course of treatment and abiding by the patient's
autonomy.
The principle of beneficence requires caregivers to do well at all times and ensure that
their actions do not adversely affect their patients. Adherence to this principle requires caregivers
to consider a patient's individual circumstances, update their training regularly, and develop
knowledge and skills. The principles of beneficence and autonomy may lead to a conflict in the
judgment of the palliative care nurse. For example, the decision by a dementia patient to stay
home may present a conflict between beneficence and autonomy principles for the carer. The
caregiver may be faced with the challenge of preventing harm or acknowledging the autonomy
of their patient (Nijhawan et al, 2013).
Likewise, informed consent is an important ethical requirement for aged care. However,
in some situation, the patient may not be in the best state to give informed consent. This
particularly may arise in case of emergencies that require urgent actions. In such cases, the
palliative care nurse will be faced with an ethical obligation of beneficence, autonomy, and
consent. Therefore, a need to contravene one of these ethical obligations may be necessitated by
the need for the best outcomes for the patient (Bester, Cole & Kodish, 2016). Additionally, they

are also required to consider the options provided by substitute decision makers, regardless of
how effective the choices are in the improvement of patient’s outcomes.
5. Strategies that might improve the provision of palliative care in aged care
Palliative care for the older is often characterized by complex and unique support and
health needs. For this reason, the elderly may receive care from multiple health professionals and
settings. With the collaborations required, keeping all the stakeholders informed about the health
and needs of a patient may be an uphill task. The use of linkage strategies may be used to
improve palliative care for the elderly. Through collaborating with other providers, sharing of
information may be improved (Shute, 2017).
Understanding advanced illness
Palliative aged care may be improved through a distinction between palliative care and
end of life care. This is a common misconception among the public and within the healthcare
circles. However, unlike the end of life care, palliative care is not only for the dying.
Understanding the difference between palliative care and end of life care can be the starting point
in ensuring that patients are provided with palliative care at the onset of their disease. Early
palliative care would be imperative for improved outcomes. Physicians should play a major role
in advancing this objective(Shute, 2017).
Mid-career training
One of the major challenges in the provision of high-quality palliative care is the lack of
adequate palliative care specialists. With the growing number of the aged population in need of
palliative care, there is a need for more specialists to meet the rising demands caused by serious
illnesses among the elderly. Midcareer training is necessary for improving symptom control, pain
management, and communication skills for all clinicians. Also, there is a need to use palliative

care specialists prudently, empowering specialists to carry out advancement research, lead
community-based teams and attend to most complex cases. It is also important to equip non-
specialists with fundamental palliative care skills. Such an approach would be important in
enabling a team-based approach in catering for the medical, spiritual and social needs of
patients(Shute, 2017).
Issue screening
With a skilled team in place, a standard approach should be put in place to facilitate
consistent identification of patients and families in need of palliative care. On top of that,
hospitals should also look out for patients with poorly controlled symptoms including repeated
hospitalization, shortness of breath or pain. Palliative care assessment should then be carried out
on those who meet the search criteria followed by the necessary interventions. Screening would
make it easy to identify cases that require palliative care and ensure that the same is offered
within the onset of a disease before it is too late for any fruitful intervention. Overall, this would
lead to improved outcomes in aged palliative care (Shute, 2017).
Increased funding
Funding is integral in the provision of palliative care in residential aged care. Some of the
challenges identified including a shortage of qualified professionals can be sorted out through
sufficient funding. Increased funding of palliative caged care is needed to support new care
delivery approaches focused on improving outcomes for people living in residential aged care by
improving the quality of palliative care (Herwartz & Theilen, 2014).
Monitoring

Monitoring would also be an effective strategy for improving the success rate in
palliative care in residential aged care. Effective monitoring is needed to identify challenges in
the provision of palliative care to the elderly. It would also facilitate identification of emerging
challenges in dealing with the aging population to enable adoption of updated strategies focused
on solving emergent challenges Monitoring would also have an impact on considerations such as
include minimization of avoidable hospitalizations and improvement of patient satisfaction.
Collaboration
Holistic care is largely dependent on successful and effective collaborations. Frequent
multidisciplinary team communications between members drawn from different disciplines but
delivering palliative care would lead to overall, efficiency. It would facilitate the sharing of best
care strategies and enable sharing of information, which is needed for improved outcomes(Shute,
2017).
Role clarification
With the collaborative efforts of palliative care in residential aged care, confusion would arise if
no role clarification is done. They include family members, support nurses, doctors, and other
professionals. Unless each these parties knows their role in palliative care in residential care, the
quality of patient outcomes would be affected. Additionally, role clarification leads to continuity
of care in the transition between settings
Conclusion

In conclusion, with the rising needs of the aged population, aged care nursing homes have
become important facilities in the country. These homes are tasked with the responsibility of
offering a conducive social environment, which plays a role in the reduction of problems
associated with mental disorders such as depression. Palliative care is caring for individuals with
life-threatening illnesses. These individuals may be young or old. In residential aged care,
palliative care is provided by a palliative nurse. The palliative care may work in collaboration
with doctors, nurses and other health healthcare professionals. The effectiveness of palliative
care can be improved through collaborations with various stakeholders. On the other hand,
advance care directives are directives by patients on their future care. Care directives help
patients to identify their care preferences in advance just in case they get to a point where they
are not able to decide Directives are used to ensure that patients consent to decisions regarding
their care. They facilitate adherence to the principle of autonomy. Advance care directives are
however regulated by both legal and ethical considerations, which guide the behavior of
healthcare providers towards their patients. Palliative care in aged residential care may be
improved through effective collaborations, training, increased funding, role clarification, issues
screening, and monitoring.

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