Guidelines for a Palliative Approach in Residential Aged Care

facets of a palliative approach are considered in their relevant chapters in this document;
however, the reader should also consider cultural issues as integral to care provision, particularly
when implementing any part of these guidelines.
Underlying the philosophy of a palliative approach is a positive and open attitude towards death
and dying. The promotion of a more open approach to discussions of death and dying between
the aged care team, residents and their families facilitates identification of their wishes regarding
end-of-life care.
A palliative approach is not confined to the end stages of an illness. Instead, a palliative
approach provides a focus on active comfort care and a positive approach to reducing an
individual’s symptoms and distress, which facilitates residents’ and their families’ understanding
that they are being actively supported through this process. [4]
The need for a palliative approach
In Australia, over the last two decades, research has indicated that the proportion of people
dying in RACFs has steadily increased. [5] This has led to the recognition that a palliative
approach enhances the care already provided to both residents and the families. [6,7]
Due to the type of residents they support, RACFs face unique and significant difficulties in
using a palliative approach. Not only do the majority of residents have dementia; they generally
have co-morbidities (other diseases) that involve dealing with physical, psychological, emotional
and social issues. The residents are generally highly dependent and require many medications,
further complicating the provision of a palliative approach. [3]
Residents in RACFs may also require a palliative approach when they are dying due to the
ageing process, that is, not only as a consequence of an incurable disease. Older persons who are
dying are considered to have different palliative needs to those people diagnosed with cancer. [8]
These differences may include, that: [8]
• they have multiple clinical diagnoses that require a variety of treatments;
• they require end-of-life (terminal) care for a shorter length of time (an average time of two
days of intense care prior to death);
• confusion, dementia, and/or communication difficulties may be present; and
• some lack family support.
Therefore, there is a special need for older persons with a life-limiting illness or who are dying as
a consequence of the ageing process to receive a palliative approach.
The need for evidence-based guidelines for aged care facilities
Although separate Australian standards for aged care and standards for palliative care exist,
these do not fully address the unique and complex issues associated with providing a palliative
approach within an RACF. The aged care literature calls for the development of guidelines for
appropriate care of older persons by non-specialist palliative teams, but to date no guidelines
for implementing a palliative approach in aged care facilities have been created. As well, there
Guidelines for a Palliative Approach in Residential Aged Care