The GP’s involvement may include home visits to review the patient and support carers and to provide ongoing prescriptions as required. GPs are supported in providing home care for palliative care patients by community nursing and palliative care services.
Planning ahead can minimise many foreseeable problems. Liaising with other services that provide care at home means that the GP can be kept informed of the patient’s progress and issues and can manage care more effectively. The palliative care service can help to support patients with more complex care needs.
Issues to consider when planning care at home
- The likely time course of the person’s condition:
- Is the prognosis days, weeks or months?
- How much care is the person likely to need throughout their last days or weeks?
- Are both the patient and their carers able to cope with this?
- The physical care of the dying person:
- Identify any issues around safety, the physical space and equipment that may be needed
- Are there problems (eg incontinence, wounds, fistulae, unstable pain, delirium) which may be difficult to manage at home?
- The emotional and physical wellbeing of carers:
- Is there enough support for both patient and carers?
- Are there others available to help the main carers with basic household tasks and to ensure they can get rest?
- Can someone be with a dependent or dying person around the clock?
- Are there household members who may be distressed (eg young children)?
- How medications will be accessed and given by the person’s carers:
- Consider what and how much medication will be needed, where carers will obtain it and issues about supply on weekends or public holidays
- Are carers confident to give medications as needed for symptoms at the end of life? Will they cope when things change (eg when the person can no longer swallow or speak)?
- What other routes of administration will the carers be comfortable to use? (sublingual, subcutaneous, nebulised, rectal)
- Is there a plan for managing any predictable crisis event?
- The after hours arrangements for professional support:
- What after hours medical support your practice can provide, including locums
- Is the patient known to the palliative care service? - most palliative care services provide a phone support service after hours
- Community nursing services may also be contactable after hours and are sometimes able to provide extra visits
- Is there a backup plan for an admission for terminal care if needed? Consider requesting the patient to be put on the waiting list of the palliative care unit 'just in case'
- What to expect and what to do when the person dies:
- Do carers know what is likely to happen as a person dies?
- What are the arrangements for certifying the person’s death?
Much depends on the patient and their carer's own resilience. However, it is important to recognise that sometimes it is not possible to provide adequate or safe care at home and to advise the family about other options:
- Inpatient care (for patient or carer distress, symptom management or terminal care) can be offered by palliative care services. Families should be counselled that palliative care services are not able to provide long-term care.
- Longer term palliative care may require admission to a residential aged care facility.
- Planned respite in a palliative care or residential aged care facility can sometimes be negotiated.
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This page was created on 26 May 2009 and is due for review in May 2011.