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Enabling best practice personal and clinical care at the end of life

 

Aged Care Standard 3 highlights the critical need for best practice and tailored care for older persons at the end of life. In this In Focus feature article, we discuss how aged care staff and organisations can address Standard 3 Requirement (3) (c). We also highlight some useful palliAGED resources that can help you and your aged care organisation.

Standard 3: Personal Care and Clinical Care

Standard 3 explicitly recognises that aged care consumers and the community expect safe, effective and quality personal and clinical care. Personal and clinical care can include a range of services such as supervising or helping with bathing, showering, personal hygiene and dressing; nursing services; services aimed at getting back or improving a consumer’s independence or daily living activities; or specialised therapy services, such as support for consumers living with cognitive impairment.

However, the standard does not provide clinical guidance. Instead, it highlights that organisations need to develop and implement an approach that ensures that appropriate personal and clinical care is delivered in line with best practice evidence. Organisations also need to have policies and procedures that support the workforce to deliver care and treatment in line with this approach.

Standard 3 Specifically Identifies End-of-Life Care

Standard 3 explicitly states the need to address end-of-life care in Requirement (3) (c). It emphasises that dying and death are not just a biological or medical event, but are part of each individual’s human experience. This understanding needs to underpin all care at the end-of-life.

Our latest palliAGED Aged Care Standards Insight looks at palliative care and end of life in Australia.

 

palliAGED Resources for Standard 3

palliAGED has resources can be used to support consumers, aged care staff and the service when considering how Standard 3 applies in the context of care at the end of life. Resources that address care quality and personalisation, identifying and responding to deterioration, appropriate documentation and communication, and timely referral are included.

Advance Care Planning

Advance care planning can enable a person’s wishes to be known when they can no longer speak for themselves. palliAGED has an evidence overview on advance care planning as well as practice resources.

Case Conferences

A family meeting or case conference can assist with communication between patient, key family members, substitute decision-makers and the care team. It can help plan care and make decisions relating to end of life in accordance with a person’s preferences. Resources and sample forms including family forms can be found in the practice centre. There is also an evidence overview.

Referral

Most older people will be able to receive palliative care and end-of-life care where they normally live. Referral for specialist palliative care may be appropriate for some people to manage severe symptoms, to respond to extreme distress or to provide specific care planning support. The Practice Centre Referral page resources can help identify palliative care services.

Specific Needs

Respect for the needs of individuals and groups with specific needs is embedded within a human rights approach to ageing and health including care at the end-of-life. Specific needs pages provide end-of-life guidance and resources about older Australians living in the community or in aged care facilities who may have specific needs. This enables staff and services to provide care that is customised for the individual.

Developing Workforce Knowledge and Competency

Caring for older Australians at the end-of-life requires a workforce that is skilled and knowledgeable. Being able to access relevant training and learning can help individuals and organisations. The palliAGED Training and Education pages provide links to a wide selection of online courses. In addition, our Practice Tip Sheets can be used by individuals or for in-house training activities.

 

"I get personal care, clinical care, or both personal care and clinical care, that is safe and right for me"

Consumer outcome statement for Aged Care Standard 3. Source: Aged Care Quality and Safety Commission website
The use of this image does not constitute an endorsement by the Aged Care Quality and Safety Commission of palliAGED activities.

 

"The needs, goals and preferences of consumers nearing the end-of-life are recognised and addressed, their comfort maximised and their dignity preserved."

Standard 3 Requirement 3c

 

palliAGED Resources for Standard 3 Requirement 3c

Communication

Communication between a person receiving palliative care, their family, and health professionals is at the core of a positive end-of-life experience. There is an evidence overview on communication at the end of life as well as practice resources. It can also be helpful to provide information on where families can learn more about end of life matters. The For the Community section in palliAGED has resources for the family and the community.

Managing the last days of life

The Symptoms and Medicines page is a resource to guide evidence-based practice in the care of older people in the last days of their life (terminal phase). They provide information on six commonly observed symptoms seen in the last days of life.

The palliAGEDgp app supports GPs and nurse practitioners in anticipatory prescribing where this appropriate to prevent unnecessary hospital admissions and support death at home where that is the person’s preference.

Up to Date Guidance on Best Practice

palliAGED’s role is to provide palliative care guidance for residential aged care and for home care. The palliAGED team ensures that content is current, relevant to the sector and comprehensive. The research evidence for 36 topics relevant to end-of-life and palliative care has been summarised. Companion pages in the Practice Centre show resources that can be used by staff and provide suggestions for use within the organisation. The Practice Tip Sheets provide evidence for use with specific sets of guidance for careworkers and nurses.

Read some of our Palliative Perspectives blogs related to assessment and care planning in aged care:

Working With Others:

There are other national palliative care projects that can develop workforce capabibility in personal and clinical care delivery. They include:

The Advance Project Logo

The Advance Project

Supports GPs, Practice Nurses and Practice Managers in initiating advance care planning and advance care conversations.

 

ELDAC Logo

End of Life Care Directions for Aged Care (ELDAC)

Offers toolkits to help residential and aged care as well as engagement with services.

 

caring@home logo

caring@home

Trains nurses to help unpaid carers to develop confidence and skills in managing medications including injectables.

 

PEPA Logo

PEPA

Provides placements and training for practising health professionals.