Guidelines for a Palliative Approach in Residential Aged Care

• What are the signs that death may be imminent?
• What are the usual changes to the body when dying?
It would be appropriate to initiate a discussion of the common changes that occur when death
is imminent, if the family have not already raised these questions.
Other important issues to raise include the following signs that may be observed in the person
who is dying:
• a decrease in consciousness;
• an inability to swallow;
• changes in breathing patterns;
• peripheral shutdown; and
• incontinence.
Assurance should be given that the resident’s comfort will be the primary goal of care. Some
questions the family may ask at this point include:
• Can we talk to them? (It should be presumed that the resident can still hear them even when
death is imminent.)
• Can we hug them (or hold hands, touch, play music, bring the grandchildren, etc)?
• What will happen to their body after they’ve died? (Assurance needs to be given that the
body will be cared for in a dignified and culturally appropriate manner).
14.4.7 Site of care
When the resident is in a shared room, the aged care team need to ensure that the choices of
the resident and their family, and of other residents and their families, are respected wherever
possible. Often the resident and family members may prefer to maintain the company and
comfort of others in the same room. A resident who is dying should not be moved without
prior consent of the resident and/or the family, except in an emergency.
Other options may include transfer to:
• an inpatient hospice if appropriate care is not available in the RACF;
• a single room in the RACF (depending on resident’s or family’s choice and availability of rooms);
• a more private space for selected periods of the day or night (depending on resident’s or
family’s choice and availability of space); and
• their home for the final days (as long as there is adequate community support services, e.g.
palliative care, and making sure to keep the RACF bed open, within the requirements of the
legislation, in case re-admission is needed. Home care may be an important option to explore
for some residents and families, empowering them in their decision-making role. For others,
of course, it may be inappropriate to discuss the option of home care).
168 Guidelines for a Palliative Approach in Residential Aged Care