Greater Choices in Palliative Care

The physical and emotional wellbeing of aged care residents in palliative care is the focus of a person-centred and holistic program being delivered to Adelaide care facilities.

Adelaide PHN introduced Advance Care Plans in Residential Aged Care Facilities (RACFs) in 2018 to document and improve care from the moment a resident enters a facility right up until their final journey through life.

This measure is being funded by the Australian Government’s Greater Choice for At Home Palliative Care program, which enables PHNs to implement locally appropriate initiatives to improve the coordination of care and boost access to a range of support services.

Importantly, it also helps more people understand their options for palliative support in a variety of settings, including family home and residential care.

After a gap was identified in the Needs Assessment process, Adelaide PHN used the Greater Choice program to collaborate with eight aged care providers to review policies and protocols at each of the residential homes.

A number of quality improvement activities were launched to build the capacity of aged care staff to deliver quality palliative and end-of-life care. Palliative care specialists used the Vital Talk Model to deliver knowledge and skills training to 140 registered nurses and 120 personal carers, which led to the development of a consistent approach to advance care planning with the resident central to all decision making.

During the pilot phase of the initiative, well-documented Advance Care Plans were drawn up for 75% of residents in 28 aged care facilities across the Adelaide metropolitan area.

The Care Plans, which are regularly reviewed and updated, give a person the opportunity to think about their care preferences for when they reach the end of their life.

The residents’ values and wishes are embedded in the care plans which provides an opportunity for the person concerned to think about when that time comes - ‘what would we want? What are our wishes?’ said Michelle McKay, Chief Executive Officer of Adelaide PHN.

“The advance care plans provide an opportunity for people to document that. To think about what is important to them. To talk with their friends and family and health care providers about that and, as much as possible, be reassured that when the time comes, their wishes are well and truly met.”

Palliative care nurse Zara Freeman praised the Greater Choice program for empowering residents to feel comfortable about death and dying. “The most valuable thing for me is that people have a really beautiful death and they die with dignity with the choices that they have aspired to through their advance care planning.

“It’s such an honour to be a part of that and to provide them with comfort and support and to know that we’re there for them. We’ve got their back,” said Freeman. A comprehensive framework has been developed to guide best practice advance care planning across aged care facilities in our region. Feedback from nurses and personal carers revealed increased knowledge of palliative care and increased confidence to recognise and report residents’ declining health status.

Nurse Freeman said the effort involves the whole team. “The Greater Choice Program has provided education and training to everyone from registered nurses to carers, to catering staff, to social workers, to administration, to other residents.”

After the initial focus on aged care, Adelaide PHN is now rolling out the Greater Choice program into community care, including workshops for clinicians on end-of-life palliative care.

The new focus is on people who want to spend their final days in the comfort and familiar surroundings of their own homes. “It’s the opportunity to help family and close friends really work with their loved ones as they go through this final stage of life and to feel that they have helped to make that as comfortable as it can be for the person who is experiencing that,” said Michelle McKay.

“It’s a really rewarding feeling. More people are ready for when the time comes.”

Adelaide PHN’s work features in a video series highlighting some of the innovative and local palliative care initiatives being implemented by PHNs across Australia, under the Greater Choice program. Click here to watch the video on our YouTube channel.

Learn more

The Greater Choice for At Home Palliative Care Program is a key initiative of the Department of Health and Aged Care, to coordinate palliative care through PHNs.

For more information visit, The Greater Choice for At Home Palliative Care Program.