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The views and opinions expressed in our blog series are those of the authors and are not necessarily supported by CareSearch, Flinders University and/or the Australian Government Department of Health.
Many people spend the last stages of their lives in aged care, and for that reason Palliative Care Australia believes that end-of-life care should be recognised as core business for residential aged care. Increasingly, aged care providers are recognising the need to ensure their workforce have the necessary skills and competencies to deliver high quality end-of-life care. Yet in spite of this recognition, access to quality palliative care services is far from guaranteed in residential aged care – particularly in rural and remote areas.
We all want the ‘best death possible’ for our loved ones and ourselves as we enter old age. So we need to ask ourselves, what are the barriers to accessing care that can support this, and will looking at the issue from a population or needs-based policy perspective help to ensure end-of-life care becomes core business for all aged care providers?
One of the statements we commonly see in research reports and in policy and service documents is a comment about an ageing population. The reality of a demographic change where people are living longer than ever before has been instrumental in driving rethinking around issues such as retirement age, superannuation access, healthy lifestyles and supportive living environments. Living longer does not however mean living forever, and an ageing population means we also need to consider how we support older Australians as they approach death.
I often hear people say that once a person enters a residential aged care facility that the caring role provided by the person’s family and friends is no longer required, and yet this couldn’t be further from the truth. Aged care staff encourage family and friends to stay actively involved in a person’s life. There are many obvious reasons why this is so necessary.
Moving homes is generally a stressful and emotional time and, for residential aged care, this can be further exacerbated by the fact that it is often in response to a crisis. Someone’s mother has been admitted to hospital after a nasty fall or the care requirements of someone’s husband has increased because their diabetes isn’t being well managed. Therefore, not only are people having to make important decisions about where they, or their loved one, is going to live, but this is generally during a time when emotions are high and various members of the family may have different opinions.
The release of the Guidelines for a Palliative Approach in Residential Aged Care (APRAC) and the Guidelines for a Palliative Approach for Aged Care in the Community Setting (COMPAC) were a significant advance in recognising and responding to changing population demography in Australia. They aimed to support the provision of palliative care for older people living in the community or in residential aged care by identifying and evaluating the evidence for care to promote quality of life for older Australians who have a life-limiting illness or who are becoming progressively frailer during old age. The two sets of guidelines were important landmarks nationally and internationally.
There is no doubt that nurses are fundamental to health care. There are over 350,000 nurses currently practising in Australia. They are the largest single health profession in Australia. But more importantly, they are most often the face of care to the person needing care. And this is particularly important to remember when thinking about the care needs of an older person who may be the last stage of their life.
Many older people spend some or all of the last year of their life at home. Some will move to residential aged care or will already be in an aged care facility. Others will live with families or friends. Some may spend time in a hospital. Nearly all will be involved with a GP and with their Practice Nurses. So not only are nurses critical in enabling good care for older Australians coming to the end of their life, they will be providing this care in many different settings.