The call for “earlier palliative care” referrals now arises where previously older people were often not referred to such specialist services until terminal phase.
Whilst this has been something the few dedicated palliative care physicians had been calling out for this for some time.
The new way of thinking about palliative care is to improve the quality of life of the patients and their families as they face a life threatening illness. The approach is about living a quality years, rather than focussing on the quantity of time you have left.
In aged care facilities, rather than than waiting till they’re imminently dying and/or experience uncontrolled symptoms associated with a life threatening illness, an Australian pilot study has shown that providing proactive specialist palliative care in residential aged care facilities has shown significant benefits.
The pilot study at Clare Holland house visited four Canberra facilities. Each month a palliative care needs round was conducted to identify residents. Case conferences were attended by these residents, their families and GP as well as staff. The goal of care was discussed and documented in advanced care plans, which contains their final wishes.
The overall outcome showed a reduction in the residents’ length of hospital stay as well as the number of hospital deaths. This resulted in better outcomes for residents and their families, and saved the health system $115,539 over three months.
However, despite these recommendations, a recent study have revealed contrasting results, reflective of the work and education still needed in this area. The Australian Institute of Health and Welfare data released the other month, showed that of the 231,500 residents with completed Aged Care Funding Instrument (ACFI) appraisals in 2014-15, 9144 residents, had an appraisal indicating the need for palliative care.
These latest figures show that not all residents living in aged care who are in need palliative support are receiving it. The study also showed that the older resident are, the more likely the facility is to be claiming a palliative care supplement from the government (through the Aged Care Funding Instrument ACFI). Around 23.2% of residents receiving palliative care had been diagnosed with cancer, with the types of cancer most often recorded being prostate cancer (21.9%) and lung cancer (17.4%).
What research and experts in the sector have recommended is that, ideally, everyone across Australia should have access to more timely referrals to ensure better quality outcomes. Providing improved access to specialist care before the resident begins experiencing end-of-life symptoms, which would require greater involvement on GPs and palliative care nurse practitioners, which would fill a gap in residential aged care.