Guidelines for a Palliative Approach in Residential Aged Care

The NHMRC (1998) recommends that people should be encouraged to make their own
decisions concerning medical interventions or approaches to care. [33] This recommendation
should also apply to residents in RACFs. To facilitate participation in decision making, the
resident (and/or their family) should be given adequate information in a way that promotes
understanding. Family members report greater satisfaction with the care their relative receives if
family members perceive that either they or their relative had control of care decisions, such as
where they would die and who would care for them [34] (Level QE). Dying with dignity involves
the right of the dying resident to choose where they wish to be cared for, where they wish to die
and whom they wish to care for them [35] (Level QE).
The provision of information about a palliative approach may also assist residents and their
families to consider a palliative approach as active care rather than the withdrawal of treatment
[24]
(Level QE). However, the reverse is also true when residents are transferred from acute care
settings to the RACF. Families may become unhappy if they believe that the transfer will result
in their family member receiving a sub-standard palliative approach compared with the care
possible in an acute care setting [36] (Level QE). Prior to such a transfer, there generally is a need
to explain to the family that good care with a palliative approach is available in RACFs.
In one of its publications, Palliative Care Australia (2002) [37] recommends four straightforward
steps to providing continuity of care. The following recommendations have been adapted from
this document:
1. Should referral to a specialist palliative service be appropriate, then this should be timely
and preferably not in response to a crisis.
2. Should acute care be appropriate, then the resident’s admission to acute care should be
quick and straightforward.
3. The resident and families should have access to the same aged care team, wherever
possible, to promote continuity of care and coordinated care delivery.
4. The resident’s team leader or suitable delegate should centrally coordinate care provided by
external services to the RACF.
2.2.1 Prognostication
Prognosis and survival time are profoundly linked, yet the methods used to identify survival
time have limitations in accuracy and precision [38] (Level IV). Therefore, caution is warranted
regarding the use of these methods.
An alternative method involves using a set of ‘trip wire’ questions that can help determine when
to introduce a palliative approach with residents of RACFs. This could be in the form of an
ongoing review or dialogue among the aged care team, family members and the resident. The
questions might include:
• Does the resident and/or the family choose treatment goals directed towards the relief of
symptoms, rather than curing the underlying disease?
• Has there been a new diagnosis? Significant diagnoses might include cancer, dementia,
multiple sclerosis, motor neurone disease, stroke or heart failure.
40 Guidelines for a Palliative Approach in Residential Aged Care