People have different views on how they live their life and it follows that they have differing views on how they want the end of their life to play out.
For those of us working in aged care, it is vital that we provide as much individualised care as possible and practical. Now that we have the new Aged Care Quality Standards in place, it is time for the radical shift in thinking that should have taken place years ago. That is, the resident comes first and is at the centre of what we do and how we manage their care with the assistance of any family and/or friends who may also be involved.
At the end of life, does this mean aromatherapy and soft music? Probably not any more for most of the residents we care for. The oldest ones did not use essential oils, so who are we doing it for? Often, for their younger relatives. As far as the soft music is concerned, it may be for the older person but more and more they are moving with the times and are requesting music relative to their era such as 50s and 60s. We need to ask, not assume.
Also, with the new Standards, we must show that we provide opportunities to take risks. This may not usually include the chance to go skydiving, but if the resident is still able and it can be organised easily, then WHY NOT? Would the resident like a packet of cigarettes after quitting 30 or 40 years ago? WHY NOT? A trip to the beach? Or a visit to the opera or a museum or a zoo? WHY NOT?
We pride ourselves on being able to provide good quality “personal” care and “activities” but why can we not think outside the square, and after ensuring that the resident is physically cared for, including pain relief, we facilitate the resident to do what they actually WANT. Lobster, thickened (or not), champagne, an ordinary piece of toast with vegemite for someone who has swallowing difficulties… Think sucking to get the taste, not chewing. Does the baker want to bake another loaf? What about the ex-nurse who wants to bandage the leg wound on the resident sitting beside her? Or does the resident just want to spend time watching a favourite film, or sit in the sun or get dressed up for dinner every night, even if it is pureed? We as nurses and carers need to put ourselves in their position and ASK what the resident wants. I realise that a lot of nurses and carers do, but we need to make this the absolute norm. We also need to promote and incorporate advanced care planning into usual practice - not only with the residents we currently care for but all those living and working around us and encourage this planning process to include as much detail as possible. And then we can pride ourselves on having provided “better” quality care.
For practice tips around person-centred care in aged care visit the palliAGED Practice Tip Sheet for careworkers and nurses.
Robyn McLean, Residential Manager, Benetas Eaglehawk