Guidelines for a Palliative Approach in Residential Aged Care

The implementation of a palliative approach in RACFs can reduce the potential distress to
residents and their family caused by a transfer to an acute care setting [42] (Level QE); [41] (Level
QE). A study of a palliative approach in South Australian high-care facilities found that 47%
(N=71) of the 151 facilities participating indicated they had provided and/or were providing
a palliative approach to approximately 10% of their residents [41] (Level QE). These findings
suggest that many Australian RACFs are already providing a palliative approach to their
residents rather than transferring these residents to other facilities.
Access to a palliative approach in rural settings may, however, be more difficult. Poor access
to a palliative care service was cited by the authors of a South Australian study as the probable
reason for the finding that rural terminally ill cancer patients were less likely to receive a
palliative approach (59% compared to 71%) [43] (Level IV). In rural and remote areas it may be
unfeasible to support a full-time specialised service; however, support from such a service can be
accessed over distance by GPs, or other medical and health practitioners via phone or Telehealth
consultation.
The type of RACF, and especially the range of medications that can be provided, tempers the
capacity for assessment and the provision of a palliative approach. If the RACF is a low-care
facility then the aged care team (including GPs) needs to be aware of the restrictions that occur
when providing S8 medications to control symptoms. (These vary to some degree throughout
Australia and therefore no generic statement can be made regarding this point.)
2.3.1 Transfers/discharges of residents requiring a palliative approach
Without the support of appropriate protocols and procedures, especially at night, the aged care
team is likely to choose referral to acute settings rather than attempting a palliative approach
in an RACF [41] (Level QE). A study of the provision of a palliative approach in RACFs found
that a third had transferred or discharged a resident requiring a palliative approach to another
facility or the community (76% to an acute hospital, 14% to a hospice, and 8% home, to their
homeland or to a different city) [6] (Level QE).
The main reason for these transfers or discharges was that the resident needed expert or acute
care or extra resources (57%). [6] The lack of resources was attributed to such factors as a lack
of time, low staff-resident ratios, insufficient nursing and personal care hours, and a lack of
education and training for all the aged care team (including GPs and volunteers). However,
where adequate skilled care is available in the resident’s familiar surroundings, the aged care
team and GPs need not transfer or discharge residents to other settings [44] (Level III-3).
Therefore, adequate support and education for the aged care team is considered essential to
reducing the inappropriate transfer or discharge of residents requiring a palliative approach in
the RACF. [6,25,41]
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 [45] (Level IV)
A palliative approach in RACFs provides opportunities for intervention, especially improved
control of pain symptoms and terminal care of residents with greater functional disability, in a
setting that is familiar to them and their family [46] (Level EO). The evidence also suggests that
many directors of nursing actively encourage residents requiring a palliative approach to remain
42 Guidelines for a Palliative Approach in Residential Aged Care