End-of-Life Care, evidence-based tip sheets for all aged care staff
A blog post written by Nigel McGothigan, Member Advocate at Leading Age Services Australia Ltd (LASA)
Gerard Hayes, President of the Health Services Union suggested in giving evidence given to the Royal Commission into Aged Care Quality and Safety that “…the morality of Australians is to be tested in the way we care for our ageing population. Older Australians, children of the 1920s, 30, 40s who rebuilt Australia after the Great Depression and the Second World War are entitled to a level of care and respect which the aged care system too often denies them ”(The Royal Commission into Aged Care Quality and Safety, 2019). 
With these sentiments in mind, as a Clinical Consultant in the Aged Care Industry, I cannot deny these hurtful and painful words. I am one of 366,000 aged care workers who continue to provide excellence in care in-spite of many obstacles and barriers faced by the Industry at this time.  Mr. Hayes’ words cut deep to the core of my being. For someone, like myself who has dedicated more than 25 years to serving the vulnerable ageing population, I must take stock. Do my actions, my thoughts, my feelings and my practice mirror Mr. Hayes’ evidence or is there something more to discern in this statement.
Whilst Mr. Hayes’ talks about a high-level process within the Aged Care Industry, my mind goes to the practical process of delivering palliative care in a Residential Aged Care Facility. In light of the constraints on the supply of the types of care, particularly skilled palliative care in residential aged care, it is unsurprising that many people who would benefit from end-of-life care do not get the right care, in the right place, and at the right time.  According to statistics produced by the Australian Institute of Health and Welfare (AIHW 2016), based on current trends, residential aged care is transforming into an end-of-life care service. 
The current funding system, which is one of the tenants of the Royal Commission, does not encourage nor support end-of-life care and services to the care recipient, let alone the family and other staff. There remains a disconnect between the funding provided for care and the actual care people receive in residential aged care. It has been reported only one in six people who died in residential aged care received funding for palliative care (AIHW 2016). In light of these concerns, reforms are needed to ensure that people residing in residential aged care receive end-of-life care that aligns with the quality of care available to other Australians.
Apart from funding; lack of education, complicated processes of referral, poor skill-mix and lack of support for staff underpin the disproportionate care delivered at end of life. How can we provide exceptional and exemplary care if we do not have the resources and tools to do so? How do I find simple and practical guidelines to assist me in delivery of care at end of life? How do I get advice and understanding on topics such as oral care, medication management, skin integrity, eye care, pain, signs and symptoms of the deteriorating care recipient and how and what to report? Where do I find one source of truth written for me as an Aged Care worker?
Enter the palliAGED Practice Tip Sheets from the team at CareSearch, Flinders University. Finally, a resource written specially for the Aged Care Industry and its workers. As the care recipient moves through their own journey in end of life, each tip sheet gives indicators of what to look for, services needed, additional assessments required and assistance for assessed need to understand the holistic approach to end of life care. The resource are colour coded and separated into two distinct information categories, (a) the Care Worker and (b) the Registered/Enrolled Nurse. The palliAGED Practice Tip Sheets are aged care focused and suggest no matter your employment status there is an incredible role you can play in the end of life care for the care recipient.
The palliAGED Practice Tip Sheets are a resource which celebrates expertise in aged care for those delivering and receiving palliative care. There are written in an easy to read format and adopt a person centred approach to end of life care.
The palliAGED Practice Tip Sheets provide simplified and concise tools of reference as a guideway to evidence based best practice. They are practical, offering flow chart step-by-step processes to achieve the outcome required. They include references for further research and indications for the need to refer to specialised services and treatment needs based on holistic assessment. With referral back to organisational documentation and handy hint; these Practice Tip Sheets will ensure all care recipient’s needs are met on their journey at end of life.
The palliAGED Practice Tip Sheets series does not neglect the importance of self-care. Acknowledging that we are people with emotions and the demands of the various roles we have in aged care can be draining on our sense of self as we give 110% to others. The Tip Sheets provide a simple way of knowing when to ask for help, pointers on how to cope with stress and the process of grief when the ones we have cared for have died. The Tip Sheets place the emphasis on caring for self in order to care for the care recipient and their significant others during their life journey, from head to toe with heart, comfort and joy. The Tip Sheets provide practical and helpful tips to care of the whole person, physiologically, psychologically, spiritually and emotionally; a journey from end of life care to death to the bereavement process and ongoing care of the care recipient, their family and ourselves as aged care workers.
- Aged Care Royal Commission first to be given powers to compel evidence in writing – as only 83 out of Top 100 providers deliver submissions by close date. The Weekly Source (Australia) [serial online]. 2019 Jan 22 [cited 2019 Mar 5]
- Mavromaras K, Knight G, Isherwood L, Crettenden A, Flavel J, Karmel T, et al. The Aged Care Workforce, 2016 (24MB pdf). Canberra: Australian Government Department of Health; 2017
- Productivity Commission. Introducing Competition and Informed User Choice into Human Services: Reforms to Human Services (3.85MB pdf). Canberra: Productivity Commission; 2017 Oct. Report No.:85
- Australian Institute of Health and Welfare (AIHW). Palliative care services in Australia [Internet]. 2019 [updated 2018 Oct 17; cited 2019 Mar 5]
Nigel McGothigan, Member Advocate at Leading Age Services Australia Ltd (LASA)