CareSearch Blog: Palliative Perspectives

One part of advance care planning that is often unseen is law. Yet law plays an important role in end-of-life care. Professor Ben White and Professor Lindy Willmott from Queensland University of Technology explains the legal aspects of planning for advance care and end of life, and how the Australian Centre for Health Law Research supports health professionals.  
 

If you were unable to speak for yourself, who would you want to speak for you? And more importantly, what health care decisions would you want them to make? Discussing your values and preferences helps determine what would be important to your future health care. Linda Nolte, Program Director for Advance Care Planning Australia discusses National Advance Care Planning Week and the importance of the making our future preferences known.

The number of Australians over the age of 65 is rising, and during the next three decades, the proportion of the population aged over 85 will more than double. This demographic change is driving significant growth in demand for aged care. The availability of home care packages has significantly expanded in the last decade to allow people to be cared for in their homes including those that require palliative care. A shift in the complexity of people moving into residential aged care has also occurred; people are older, frailer and have more complex care needs. Across the spectrum of aged care services there is a need and expectation for people to have their end-of-life needs met.

As a young doctor I spent some time working in a palliative care hospital in the early 90’s.  It was such a privilege to be working with people at end of life - with the opportunity to make a difference to quality of life and well-being of patients, and their family members. That experience made me decide to devote my career to Palliative Medicine.
 
I had some experiences at that time that stayed with me.
 
I had a patient, Marion, who had been a school principal. Marion had suffered a severe stroke. She had survived but was very incapacitated, confined to bed and unable to communicate. She was being kept alive, surviving on a feeding tube, and facing a life of care and dependence. Her specialist was very committed to her survival.
 

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.