Guidelines for a Palliative Approach in Residential Aged Care

• Has the resident had a recent decline in functional status (e.g. bathing, dressing, mobility,
verbal communication, energy level, and mood)?
At some point the severity and number of symptoms may increase, with the resident’s
condition rapidly deteriorating. These situations may not allow for slower-paced discussions
with the resident and their family. Nevertheless, the principles of symptom management
should be followed to ensure that the resident is able to receive optimum comfort and relief of
symptom distress (see Chapter 6, ‘Physical symptom assessment and management’). Regular
communication with the resident’s other care providers becomes particularly important, and
documentation of who is involved in providing care needs to be current.
Members of the aged care team also need sound interpersonal skills and good listening abilities
to help the resident talk through issues such as their wishes and hopes for the future in the
context of their advancing illness. The transition through the decision-making process may
also be stressful and the resident and family should ideally be involved in this process. Conflict
between the resident and family members may surface or may even be exacerbated during these
times. The aged care team needs to help the resident’s family accept the decision of the resident
whenever appropriate, because in most instances the decision to accept a palliative approach
should be the resident’s [39] (Level QE). However, the views of the family are also relevant and
need to be understood [40] (Level EO).
Guideline:
When should a palliative approach be implemented?
Ref No.
Evidence level
1. Methods used to identify survival time, such as physicians’ clinical
predictions, have limitations in accuracy and precision resulting
in overestimating survival. Therefore, relying only on these
methods to determine when to start a palliative approach is not
recommended. Aged care team members need to be aware of
this tendency to overestimate survival, to reduce residents’ and
families’ potential distress.
2. Attention to residents’ transition from active curative care to
palliative care (with comfort care and symptom management)
requires that aged care team members provide the resident and
their families with sufficient information about the transition
process to facilitate decision making. This provision of information
can reduce residents’ and families’ concerns and increase their
satisfaction regarding the appropriateness of a palliative approach.
38 IV
24, 35 QE
2.3 WHERE CAN A PALLIATIVE APPROACH BE
PROVIDED?
A palliative approach can be used in any setting, [41] and should ideally be provided wherever
people who require this approach reside. Therefore, RACFs may be an appropriate care
setting because residents in RACFs face many of the same issues as others with a life-limiting
condition [42] (Level QE).
Guidelines for a Palliative Approach in Residential Aged Care 41