Supporting a ‘good death’ in residential aged care settings

Palliative and/or end-of-life care is an important and recognised function of residential aged care (RAC). The practical business of RAC is quality, person­centred care for older people whose lifespan will include an end to life. Concepts of end of life (EoL) and death remain difficult social conversations, even for experienced and empathetic health professionals. Literature is challenged by interchangeable terms related to palliative care, advance care planning, resuscitation or life sustaining treatments; including poor understanding of cure-(a)-tive and comfort-(a)­tive) care. Lack of standardised terms/documentation is unhelpful, creates uncertainty in decision making; particularly if the person is unknown to the care provider. Currently, advance care planning documents can otherwise be known as: advance care directives; advance care plans; Eol wishes and others. Terms such as 'not for resuscitation' are unclear, particularly in events where provision of short term treatments akin to resuscitation (e.g. IV fluids, ABs) can improve a person's medium/long term  quality of life. Conversely, unrealistic care goals, lack of discussion, and poor communication of illness trajectory with residents/families hinder efforts to implement a palliative approach to care in support of a 'good death'. This presentation explores the issues from resident and aged care provider perspectives and proposes solutions at system/industry/sector level.