Question:
This is the Task: Write an Essay on the Following Topic.
Discuss the ‘palliative approach to residential aged care’ and discuss how it might be used in practice.
You should also discuss policies regarding residential aged care funding models and advanced care directives.
Discussion on what an oaliatrve approach looks like and which systems can be used to promote a palliative care approach in residential aged care at both a national level and internationally
Discussion and exclusive of issues related to providing palliative care in residential elderly care.
Also, this should include discussion about how aged services are funded and how it impacts palliative care in aged care.
A longer essay should include an introduction, body, and conclusion. Subheadings can help with this structure.
The term panelme approach and the term “end of life care” are terms that can be used to describe contemporary literature.
Advanced care directives can be discussed in a paricular fashion from an ethical perspective
Consider how a palliative approach to end-of-life care could ante d funding of reSidental Car faCilities
These approaches and concepts should be critiqued with reference to the literature
Answer:
Introduction
Palliative care services aim to prolong the lives of patients with advanced disease.
Palliative care is provided to patients with terminal illness.
According to the World Health Organisation (Zimmermann and co., 2014), palliative care provides care to patients with life-threatening illnesses to improve their quality and life. It is provided by experts who recognize, assess and treat pain as well as psychological, physical, and spiritual problems early on.
Palliative care can be provided in many settings, including paediatric and neonatal units, acute hospital, residential aged care, community, and home care.
Specialist services are provided by community-based, inpatient, and hospice care (Parker, et al. 2013, 2013).
This paper focuses on Palliative care in end-of-life care in residential aged care at both a national as well as international level.
This paper is an analytical demonstration of palliative care. It also demonstrates how this approach can be synthesised with evidence regarding its use in practice and policy.
This paper examines the implementation of palliative care for older persons.
This paper examines policies regarding advance care directives as well as the funding models for residential aged care.
It also discusses issues related to palliative care, and their impact.
Palliative Care
Palliative is a Latin word that means “relieving without cure” and comes from the Latin “palliatus”, which means “hidden or covered with cloak”.
Palliative care provides care for patients with advanced and active disease who have no hope of receiving care.
This includes patients with advanced cancers, as well as non-malignant conditions like heart disease, dementia, motor neurone disorder, respiratory failure and renal failure.
This approach affirms life and provides pain relief as well as relief from other distressing symptoms.
This approach considers dying normal and tries to prevent it from being prolonged or hastened (Parker et. al., 2013).
Some countries make a distinction between hospice care and palliative care.
Both approaches share a similar philosophy.
The distinction in the US is not made and they differ in the way that services are paid and where they are located.
The hospice and non-hospice palliative care teams in the UK provide care for patients with all stages of illness. It is not possible to cure.
Many professionals, even though they are not specialists in health care, still use palliative care principles in their daily work (Free 2018, 2018).
Palliative care is a key competency for all health professionals in Australia (Broad and al., 2013).
Culture is an integral part of a person’s life journey.
A person’s life is shaped by their culture and spirituality.
Many cases have shown that religious and spiritual affiliations, as well as cultural backgrounds, can strongly influence health beliefs (Mazanec and Panke 2015).
Palliative care combines the spiritual, cultural, and psychological aspects of palliative care to ensure that a patient lives active until death.
Palliative care also considers the needs and wishes of the family, such as how to cope with bereavement (Free 2018).
End of Life Care
End of life care is offered to patients during their last months and years of life.
This includes patients who are at risk of death, such as those suffering from advanced cancer, stroke, dementia, or people who have suffered a life-altering event.
The care is designed to make a person’s death as dignified as possible and help them live as long as possible.
When providing care, the wishes, preferences, or perspectives of family members are considered.
These patients have the right to high-quality care. They can express their preferences and wishes for care at home, hospice or care homes.
End of life care is provided by the hospital doctors, nurses and community staff.
If the patient is receiving care at home, general practitioners are responsible for providing overall care.
In cases where the illness is curable, palliative care may be included.
This is done to offer comfortability to patients (Virdun et. al., 2015).
Palliative Care in Residential Aged Care
National and international residential aged care facilities are designed so that medical professionals can access patient files and enable the palliative approach be implemented as soon as possible.
Residential aged care facilities are best suited for the palliative approach. This allows for open communication between patients and aged care professionals (Tuckett, et al. 2015).
These facilities make sure that qualified staff are available to provide high-quality care at all times.
The right mix of skills is required to reduce the number of patients being transferred to acute care settings and to minimize the potential distress for the elderly person and their families.
Staff in aged care have to be involved in continuing professional education and education on the palliative approach.
There are many elements to the palliative approach in an aged care facility.
It incorporates the principles of autonomy, dignity and respect as well as comfort.
It includes the principles of honest and open communication with aged adults about their current condition and treatment options.
The palliative team must offer options to older adults using evidence-based treatments.
The palliative approach to end-of-life care includes pain relief and effective management of distressing symptoms.
It provides people with the access they desire and takes into account cultural and spiritual desires (Mazanec and Panke, 2015).
Palliative care teams work hard to improve patient’s quality of life and provide care that can be combined with other therapies that could prolong their lives.
The goal is not to speed up or delay death (Free 2018).
Spiritual considerations include providing resources like pastoral care workers, meditative songs, aromatherapy resources and objects of personal significance to people that can provide comfort and relief (Lopez Sanchez & Rodriguez Sanchez, 2015).
Parker et.al.
The medical practitioners direct the care of elderly people living with life-limiting illnesses in residential aged care facilities.
Practioners are responsible for prescribing medications and making effective decisions related to treatment.
This is where the practioners are crucial.
It is important that the practioner understands the differences between palliative care and acute care.
The medical practitioner must ensure that palliative care is provided for the elderly at the end-of-life and people with chronic conditions.
It is important to give care that is based on comfort and not cure-focused.
But, proper care doesn’t mean sending an older patient to the hospital.
(2014) stated that palliative care should be limited to distressing interventions, even if symptoms can be treated in-situ.
Some hospital visits may be required to provide comfort.
It is important to provide relief for distressing symptoms by using positive approaches and taking into consideration cultural and spiritual needs.
Communication and planning that are sensitive to the cultural and spiritual backgrounds of care users is an important part of palliative care in aged care facilities and end-of-life care. Practitioners must have open communication with older adults and get consent from their loved ones before making decisions.
Patients and their loved ones must be able to understand the different service options and treatment options and the realistic outcomes.
This is what will enable them to make informed decisions (Keeley 2016).
Sometimes, an older adult with a condition that is unpredictable may make it difficult to communicate effectively.
For communication and discussion, it is necessary to have collaboration between residential aged care, primary care providers, disease-specific organisations and specialist palliative services (Petriwskyj and co., 2014).
Processes of Palliative Care for Residential Aged Care
The Palliative approach to residential aged care in Australia includes advance care planning, or ACP.
ACP allows the relatives of patients to make decisions for them, such as how they would like to live until death.
This may be useful in cases where the patient is unable to make life decisions.
ACP helps doctors respect the wishes and needs of loved ones in regards to health insurance, care, and other matters.
ACP is initiated if the prognosis is greater than six months. Patients are reviewed every six month.
It is not an event to communicate and document wishes. Instead, it is an ongoing process of communication and discussion that begins soon after residents are admitted (Street and al., 2015).
People may be clear about what end-of-life care means, but there are differences in how they prefer to do it.
Advance care directives, or ACD, are a way for people to plan ahead and take into account cultural factors when making decisions.
ACD is a systematic way to make decisions while still respecting the wishes of the individual.
Both at the national and international levels, residential aged care services use ACD to facilitate the transfer of information between clinicians, health care professionals and residential aged care facilities.
The future decisions are made based on the individual’s beliefs, values and preferences. (Crispin & Bestic, 2015).
ACD is a formal advance care plan that has been written and is signed by the individual and recognized by the common legislation.
ACDs are used to inform plans for clinical care and resuscitation (Petriwskyj, et al. 2014).
Tuckett et al. (2014) state that palliative care conference and the use of an end-of-life care pathway are key processes. However, it is essential to have open and ongoing communication between all members of the residential care team.
If the prognosis for palliative care is less than six months, and patients are being reviewed monthly, then case conferences can be initiated.
If the prognosis for end-of-life care is less than one week, a pathway to that care is initiated. Patients are reviewed daily.
Care facilitators need to be informed about the prognosis for each patient.
A meeting between the palliative care team and residents, including their families, is held during palliative care conferences.
This meeting focuses on the current state of residents and identifies the care goals (Reymond 2014).
A clinical document is used to guide the provision of high-quality care during the final phase of illness in end-of life care.
If there is improvement, he/she will be removed from the end-of-life care.
Normal care is resumed (Reymond and co., 2016).
The Key Issues
The ethical decision-making process and legal obligations are the main challenges in residential aged care facilities that use palliative care.
The most important ethical issues relate to advance care planning and documentation as well as burdensome treatment, poor life quality, pain management at the end, and issues related to nutrition, hydration, and treatment adherence.
Families often have difficulty making decisions about the patient’s request for death and resuscitation.
Care providers must make decisions that are based on the principles autonomy, beneficence. non-maleficence. and justice (McLennan and al., 2015).
It is difficult for countries such as Australia to retain autonomy with respect to different religious and spiritual beliefs.
For example, Aboriginals and Torres Strait Islanders have different beliefs from Non Aboriginal Australians.
Different communities have different perceptions of what “quality life” means.
Accordingly, the substitute decision-maker of the patient can accept or reject the intervention in an ACD. (Stokoe and al., 2015).
It is often difficult for care providers to recall different ways of showing respect and reacting to death and dying.
Language can be a barrier in many cases.
It is assumed that everyone can understand and speak English.
Interpreter and translator services are essential to palliative care.
These services are essential in order to address the spiritual aspects of palliative and legal care. This will delay the discussion until the death is certain.
Insufficient knowledge and skills of staff, as well as lack of awareness of the importance of considering the person’s values and goals, can delay informed decisions and advance care planning documentation (Connolly and al., 2014).
Australia has a variety of legislation that covers ACD. These laws include the names and natures of the legislated instruments.
The key issue is the change in preferences over time. This may not be updated on ACD.
Sometimes, the medical instructions, which are uninformed, cannot be modified during medical treatment.
Different countries have different advance care policies and best practices.
Inappropriate documentation and the transfer of information can lead to lawsuits (Broad, et al. 2015).
The UK has several legislations that provide a framework for the administration of medications without prescription.
Residents with dementia or communication difficulties can make it difficult for residential aged care to provide palliative care.
Under the Australian aged care funding instrument, permanent residents are considered to be in need of palliative care.
As the resident ages, the funding percentage increases.
These systems have been subject to numerous reforms.
The guidelines developed by the Australian government for a palliative approach address inequalities in residential aged care centers.
These centres are funded differently from multi-purpose services. This has an impact on the provision of end-of-life care in residential care facilities.
These facilities are funded based on individual care needs, whereas multi-purpose services units are funded based upon the agreed number of beds required to provide care. This gives these services a consolidated income.
The residential classification scale is a major problem in palliative care delivery.
Most palliative care inpatients who are referred to residential aged nursing die before being discharged. Therefore, it is important to carefully place them.
The repayment of capital grants may be deducted from the amount in certain cases.
Even though there are capital grants for rural and regional areas, residential care cannot be accessed because of geographic limitations, insufficient non-grant funding to complete capital work or residents with low incomes as described in the Aged care Act.
A rising demand for aged care services adds to the burden (Sung and al., 2014).
Conclusion
The palliative care is a holistic approach to caring for patients suffering from life-threatening illnesses that have no cure prospects.
This approach addresses the patient’s emotional, spiritual, and cultural needs.
The literature review shows that the demand for palliative care will increase in the near future.
These services should be aligned with WHO recommendations.
It is necessary to assess any unsatisfied needs and any other diagnoses that may indicate the need for palliative care.
If the palliative approach to residential aged care facilities does not include cultural, spiritual, religious and belief values and beliefs, it is an ethical and legal violation.
Clear preferences are essential and must be implemented in order to preserve decision-making capacity.
A systematic approach to ACD is essential.
ACDs must be planned and communicate well to ensure the services meet the needs of the patient.
Refer to
The likelihood of residential aged care being used in later life: An easy approach to estimation using international comparison.
Journal of Public Health, Australia and New Zealand, 39(4): 374-379.
A comparison of international deaths in residential aged care and hospital settings for 45 people using publicly available and published statistics.
International Journal of Public Health, 56(2), 257-267.
Residential aged care: New Zealand’s de facto hospice.
Australasian journal of ageing, 33(2): 114-120
Advance care directives for residential aged care.
Australian family physician, 44(4):186.
End?of-life and palliative care.
Acute Medicine?A Practical guide to the Management Medical Emergencies, 5th edition, 625-631.
The International Encyclopedia of Interpersonal Communication.
A literature review on the supportive role of religion and spirituality for end-of-life care and palliative treatment of cancer patients in a multicultural context.
Current opinion in supportive care and palliative medicine, 9(1): 87-95.
Cultural considerations in palliative Care
Cultural, Spiritual and Religious Aspects of Care
Relinquishing control or taking back control?
Community perspectives on the barriers and opportunities of advance care planning.
Australian Health Review, 39(5): 528-532.
General practitioners’ views on Palliative Care Case Conference (PCCC), in Residential Aged Care (RAC).
In APCC2013: 12th Australian Palliative Care Conference.
Palliative care is everyone’s business.
Centre for Palliative Care Research and Education.
A systematic review of the quantitative literature reveals that family involvement is important in the decision-making process for residents with dementia in residential aged care.
International journal of evidence-based health care, 12(2): 64-86.
Care as a model.
End of life Care: Proactive Clinical Management for Older Australians in Community
The Royal Australian College of General Practitioners 45(1-2).
Retrospective cohort study of accessing specialist palliative care during the last year of life. Who is still missing a decade later?
Staff in residential aged care facilities and primary care doctors discuss the challenges of caring for residents who are acutely ill in aged care facilities.
For older Australians who present to the emergency department in the community or at residential aged care facilities, advance care planning is available.
23(5), 513-522.
Assessment of palliative care unit patients for residential aged care placement: Is it worth it?
Journal of palliative medicine 17(2): 204-208.
A perspective from Australia on the palliative care conference in residential aged care.
Part 1.
Part 1.
A perspective from Australia on the palliative care conference in residential aged care.
Part 2.
Part 2. Progress in Palliative care, 23(1): 9-17
Death in a hospital setting: A systematic review and quantitative analysis of qualitative studies to identify the most important elements of end-of life care for patients and their families.
Palliative medicine 29(9): 774-796.
Cluster-randomised controlled trial of early palliative care in advanced cancer patients:
The Lancet, 383(9930), 1721-1730.