Careworkers provide personal care and support to residents in aged care. They are the largest group of workers in aged care. Careworkers are also involved in supporting residents with palliative care needs. Many careworkers express satisfaction at being able to continue caring for residents at the end of their life. However, sometimes this can be a cause of stress and anxiety.
Careworkers may be concerned about some or all the following issues:
- if they have the skills to provide care for residents at the end-of-life
- how to answer questions from residents and their families
- if they feel adequately informed of changes to resident’s care
- whether they are they giving the right care
- understanding when and how decisions are made to withdraw some forms of treatment
- being included or informed about care plans
- whether pain relief is adequate, or that too much medication is given.
Morphine is a safe and effective pain reliever, it rarely causes side effects. It is the underlying disease process that causes death.
What residents and families want
Many residents in aged care may die slowly over some months or even years. Palliative care is more than the last few days before death. Living well, even as death approaches, can be very important to residents.
When residents who dying are asked "What is important to you", they indicate they:
- wish to maintain contact with the outside world
- wish to maintain social contacts for as long as possible
- want to be useful and not to be a burden. 
When asked "What care do you want your relative to receive?" family members commonly want:
- adequate pain relief
- good hygiene including oral care
- to be treated with dignity and respect. 
For many relatives being able to continue helping care for their loved one, as they would have done at home, is important. Families may also want to feel that all that could be done was done for their relative. This can assist families to grieve. However, sometimes this is a source of tension between careworkers and families.  The Registered Nurse can resolve issues. If the family is helping in care, this should be documented in the care plan.
When someone asks a question that you cannot answer, try responding to the feelings behind the question. The person will feel valued and cared for, even when you can’t give them an answer. Use simple, but honest statements like; “Mrs Smith I know how worried you are, I will inform the RN of your concerns and he or she will speak with you.”
Dignity and respect are seen as being allowed to make choices about their care, including the time of care. Dignity means having those choices respected. Dignity is also defined as:
- being treated as an individual
- being called by preferred name
- having privacy respected
- having a sense of purpose, and
- receiving assistance with care when it is needed. 
Many residents who require palliative care are unable to state their preferences. When others make decisions on behalf of a resident, there are two questions they can ask to understand what they should do.
- What is in the resident’s best interest?
- What has the resident said or done in the past that would suggest what they would want us to do for them now?
Many residents may already have an advance directive. This may say who should make decisions on their behalf. It may give directions for specific care. Advance directives assist families and health care professionals to follow the resident's wishes.
How Careworkers can help
Careworkers can make an important contribution to helping meet the resident’s palliative care needs by:
- doing the simple things well, and paying attention to detail. Care given competently and respectfully will be noticed and appreciated, by resident and family
- assisting the resident to “continue to live while dying”, to follow usual activities or interests as much as possible
- recording and reporting observations about a resident’s pain and response to pain relief accurately
- reporting pain observations during carer movement of resident
- recording and reporting resident’s likes and dislikes, behaviours and responses to care ensures that the resident’s preferences will continue to be respected, even if they cannot communicate
- minimising noise and disturbance in the vicinity of the resident reduces distress for the resident and for family members
- recording behaviour and pain observations accurately and in a timely manner to ensure good care planning and funding claims under ACFI.
Many relatives find comfort in talking about their loved one, as they were in the past, and appreciate someone listening to their story. It helps them to feel that staff understand the person he or she was and to treat them as an individual. You don’t have to say much, just take the time to really listen.
Looking for further education in palliative care?
Palliative care education for careworkers is a compulsory component of the Certificate 3 in Aged Care (CHC 30208) and an elective in Certificate 4 (CHC 40108).
RCN UK has produced an orientation guide for new health care assistants. Much of this resource is applicable to careworkers in aged care, especially the sections on communication, respect and dignity. It is a free online learning course, but you need to register on First Steps.
Concern has been expressed for some time that there is no agency responsible for regulating or monitoring the conduct of careworkers at a national level. The Council of Australian Governments (COAG) Health Council has developed a national Code of Conduct for healthcare workers.
The Code has been implemented in NSW, SA and Queensland and is under consideration in other states and territories. A national register of persons found to be in breach of the National Code will be created.