Guidelines for a Palliative Approach in Residential Aged Care

Depression was also found to occur for wives following the placement of their husbands in an
RACF [317,318] (Level QE; Level QE). Such a transition was likely to involve stress, loneliness,
identity changes, ambivalence, and a sense of loss and grief (e.g. guilt, anger) [318] (Level QE) for
residents, family and carers. However, if residents and their family were involved in decision
making [319] (Level QE), and were supported pre- and post-transfer, they reported higher levels
of satisfaction [316] (Level QE).
Recognition by the aged care team that family members have contributed significantly to the
resident’s wellbeing prior to admission may also help build a positive partnership [307] (Level
QE). Similarly, giving the family the option of having an ongoing care-giving role can also help
them cope with any separation anxiety they might feel and can also provide positive benefits for
their family member with dementia [319] (Level QE). Keeping families informed and responding
to any dissatisfaction they express about the care being given may reduce the complexity of the
family’s grief reaction and guilt over the resident’s admission to the RACF [307] (Level QE).
8.3 DOCUMENTING FAMILY RELATIONSHIPS
When the aged care team has an understanding of the social relationships and functioning of a
family they are better able to provide appropriate family care [310] (Level QE). This can be aided
by such tools as a genogram (see Appendix K) or an ecomap (see Appendix L), which help
visually document the resident’s significant relationships. The genogram usually includes three
generations and covers the basic family structure, information on individual family members
and family relationships. Discussion while constructing a genogram typically focuses on family
illnesses, deaths, stress, and coping mechanisms of the resident and the family [320] (Level QE).
The ecomap extends beyond the genogram to include formal and informal social supports. It
can therefore help in assisting the aged care team to understand the broader experience of loss
and grief for those whose friend or relative is admitted to residential care.
An ecomap or genogram can also include information such as the type of participation
individual family members wish to have in the care of the resident. Family members can raise
at this time their need for training so they can be involved in daily activities such as feeding,
particularly if the resident has swallowing difficulties. It is important to remember, however,
that not all families wish to be involved in the ongoing care of the resident and this should be
accepted and respected by the aged care team in a non-judgmental manner, as is illustrated in
the following story.
Vignette 9: Joan’s story
Joan always appeared aloof and distant on the infrequent visits to her husband. Now that
Joan’s husband Tom was dying, the aged care team wanted to involve Joan by encouraging
her to visit more often and to assist with his care. Joan felt there was an expectation
placed upon her, until she explained the situation to a nurse she trusted: “I know I may
seem uncaring but I’m exhausted from looking after him 24 hours a day at home. I just
can’t do any more. We haven’t been a close couple for many years and I find it such a
relief to have some life of my own at last”. When this explanation was conveyed to other
members of the care team, it reinforced the concept of individualised care, grounded in a
comprehensive assessment of family processes, expectations and goals.
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