Evaluating a transition model from palliative care to residential aged care: What have we learnt and what needs to change

"Collaboration in Trust and Care" is a partnership project between Calvary and 2 local high level aged care facilities (nursing homes) and 2 Divisions of GPs. It was funded by the Department of Health and Ageing from April 2006 to March 2009. This paper will report on the key outcomes from that project.

The aim of the project was to improve on baseline research findings regarding the experience of patients being transferred to nursing home from inpatient palliative care units in Sydney. These findings showed survival times following transfer to nursing home were usually under 3 months (not long enough to benefit from the transfer) and that bereaved relatives found the experience distressing.

The paper will outline the project protocol, a way of taking aspects of the hospice into the nursing home, and will also report an the evaluation process and the outcomes. Survival times fallowing transfer to nursing home improved significantly for mast transferred patients. Interviews with a sample of these residents and their family members showed an improved level of satisfaction with their transition experience. Results will be discussed.

Surveys and focus groups were held at the 2 partner nursing homes and at Calvary. Nursing home staff highlighted the difficulties they experience in caring for high needs palliative residents. Staff at Calvary expressed their appreciation for the support from the project in this difficult aspect of discharge planning. These findings will be reported.

Given the current context of limited specialist palliative care beds and the growing needs of the frail elderly population with palliative needs, we need to develop best practice models in this area.