Guidelines for a Palliative Approach in Residential Aged Care

CHAPTER 14
END-OF-LIFE (TERMINAL) CARE
How people die remains in the memories of
those who live on. [392]
This chapter focuses on care of the residents and their families when death appears imminent.
The key points are discussed, but other publications — such as the Oxford Textbook of Palliative
Medicine, [56] Therapeutic Guidelines: Palliative Care [109] and Care of the Dying Patient: A Pathway
to Excellence [393] — should also be consulted to complement the information given here. Many
of the symptoms discussed should also be considered alongside other references to symptom
management in this document.
14.1 WHAT IS OPTIMAL END-OF-LIFE CARE?
The quality of end-of-life care can vary from person to person, due to differing beliefs, values,
culture, spirituality and basic assumptions. This makes the term ‘optimal end-of-life care’ difficult
to define, and even more difficult to accurately measure. Despite these obstacles, various theories
abound as to what are the common factors that exist when optimal end-of-life care is achieved.
The following list should help aged care team members raise their awareness about some of these
common factors for optimal end-of-life care. Residents who are dying may need to:
• know when death is coming, and to understand what can be expected;
• be able to maintain a sense of control and have their wishes given preference;
• be afforded dignity and privacy;
• have control over pain relief and other symptom control;
• have choice over where their death occurs (RACF, home or elsewhere);
• have access to information and excellent care;
• have access to spiritual and emotional support as required;
• have access to a palliative approach;
• have control over who is present and who shares the final moments;
• be able to issue advance care plans, which ensures that their wishes are respected;
• have time to say goodbye; and
• not have life inappropriately prolonged.
(Adapted from the Centre for Policy on Ageing, 1999) [394]
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