Palliative care for older people - World Health Organization ...

Box 9.3. Training in end-of-life care in ScotlandThe project involves training care home staff, mainly caregivers and staff from day care centres for older people,in the principles of palliative care. This includes the physical, mental and spiritual needs of the residents andtheir families. The project is the result of collaboration between older people’s services, social work, residentialhomes (initially eight care homes and four day care centres) and a care home liaison team. The team facilitatesthe implementation of the training pack Foundations in Palliative Care developed previously by MacmillanNurses. The programme consists of four modules (one per week), evaluations by participants and adaptation.Implementation is planned to cover all care home staff in Lanarkshire.Source: personal communication, Ann Hamilton, National Health Service Lanarkshire, Scotland.Box 9.4. The Gold Standards Framework for care homesThe Gold Standards Framework for care homes (8) is part of the End of Life Care Programme in the UnitedKingdom. It is a framework of enabling tools, tasks and resources used in care homes for older people, with trainingand central support from the Gold Standards Framework team and local support from facilitators. The focus ison organizing and improving the quality of care for care home residents in the last year of life in collaborationwith primary care and specialist palliative care teams and reducing the number of residents being transferred tohospital in the last week of life. The framework is adapted to meet local needs. To date, the framework has beendeveloped and implemented over five phases. An observational evaluation of the first large-scale roll-out showeda reduction in hospital deaths from 18% to 11%. Examples of potential cost savings in pilot homes, using asample size of 437 people getting care, include: (1) decreased crisis hospital admissions (12%); and (2) decreasedhospital deaths (8%), which potentially equals an estimated saving to the National Health Service of about£40000–80000 per care home per year depending on home size, turnover and tariffs (9).Source: Badger et al. (10).Box 9.5. Guidelines for a palliative approach in residential aged care, AustraliaIn recognition that a palliative approach has much to offer residents in care homes and their families, the AustralianPalliative Residential Aged Care project team produced evidence-based guidelines to provide support andguidance for the delivery of a palliative approach in the 3000 residential aged care facilities across Australia (11).The guidelines incorporate the best scientific evidence available regarding all facets of this approach, includingthe early identification and treatment of physical, cultural, psychological, social and spiritual needs. Guidelinetopics include: place and provider of care; dignity and quality of life; advance care planning; advanced dementia;pain management; fatigue; nutrition; hydration; cachexia; mouth care; bowel care; complementary therapies;psychological and family support; Aboriginal and Torres Strait Islander issues; and the role of management.Source: Australian Palliative Residential Aged Care (APRAC) Project, Edith Cowan University (11).31