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Nurse committed to residents being able to die at home, away from hospital emergency departments

Melissa Millar says HammondCare education has enabled staff to better support dying residents' families.

Having worked as a nurse in a hospital emergency department, Melissa Millar has seen first-hand the trauma that can occur when someone who is dying an expected death is put in an ambulance. It’s something she is keen to avoid in her new role at a Sydney aged care facility.

Having worked in a hospital emergency department for 12 years, Melissa Millar has no trouble recalling sad stories about elderly people arriving by ambulance. Rather than being able to die an expected death at home, which was often a residential nursing facility, they were transported to hospital to die.

“One time was absolutely horrendous,” recalls Melissa, a registered nurse.

“A lady who was 101 was in the ambulance, on a trolley. She was at the very last moments of her life, but the nursing home could not be convinced to let her stay there.

“She died within an hour [of arriving].”

“All the [accident and emergency] staff were absolutely appalled. That is just one of many, many examples. I remember saying, many times, ‘Why are these people not dying at home?’.”

In February this year, Bupa opened a new 76-bed aged care facility in Seaforth, Sydney, and Melissa started in a new role as clinical manager. Within weeks a resident died an expected death at the facility. While staff had anticipated her death and prepared for it, the death came as a shock to the resident’s family.

“They were of the mindset that [their] mum was going to be here for a long time,” says Melissa.

“Her death was comfortable, but we felt there was more we could do, especially to support the families. I could see that we needed to be proactive and start getting more education for staff, so they felt empowered and could then support families better.”

Melissa learned that HammondCare offered palliative care education for residential care staff. She organised sessions for all staff, including registered nurses, assistants in nursing and ancillary staff.

“Our cleaners have a lot to do with our residents and have some lovely rapport,” says Melissa.

“Part of our plan is to empower all of our staff to notice changes and feel they can come forward and say to the RNs (registered nurses) this person is doing this and it doesn’t look right.

“It also opens staff members’ eyes to understand why people stop eating, why they start sounding noisy and gurgly. When they are not afraid of it, they can focus on what we can do for comfort — not just for the resident but also their relatives, so they understand their loved one isn’t in pain.”

She says staff who don’t have a clinical background are now piecing together subtle signs; noticing when a resident’s appetite has declined, they’re less mobile and sleeping more. Recognising when residents are entering their final weeks of life enables them to be more vigilant in preparing to make the process of dying as calm and dignified as possible.

“It also gives us time to get the relatives prepared,” says Melissa.

“Even when people are 90 years old, relatives sometimes think they are going to live forever.

“We needed the support of the relatives because it’s a transition for the person dying and so it’s important for relatives to understand and accept what is going on.”

Melissa says no-one should die alone. When family members need a break, or residents don’t have friends or family nearby, staff or trained volunteers sit to hold their hand and offer company. And comforting lighting, fragrance and music can be offered with palliative care boxes, located on each floor of the facility.

Staff from Bupa Aged Care in Seaforth, Sydney.

Residents’ end-of-life wishes are documented and their medical needs are anticipated. Melissa works closely with the facility’s GP, who knows each of the 76 residents. They predict what medication may be required, order it under the resident’s name, and keep it on site. The facility has a syringe driver and medication for secretions in stock.

“We don’t’ want to bring in a random doctor who doesn’t know these people,” she says.

“Our idea is hospital avoidance whenever possible and to treat within the home.”

Melissa says a care manager was concerned that the body bag used by funeral directors was not adequately dignified, so staff now place a dedicated blanket over residents as they leave the building for the final time. Staff have the opportunity to say goodbye and participate in a debrief session if there is anything concerning them.

“The girls here need to debrief because they are so involved in people’s lives. Some of them haven’t dealt with death before, so I tell them some of the little things I do to be able to get through, so you don’t take it home with you and have it brewing.

Melissa, who has been nursing for 22 years, says it took her a long time to understand that it is okay to cry in front of relatives.

“It allows you to let go; because you can keep everything so tight and wound up.

“It is okay to take a moment and have a cry with the relatives; to give them a hug, and say farewell with them.”


Comments

  • Brilliant work Melissa please keep forging along these avenues...to die is inevitable but we need dignity for all in the palliative care system

    - Jane Mosterd
  • Wonderful ,wouldn't it be great if this applied in all nursing homes.Our mother is in a nursing home ,she is 88 and has dementia ,would love something like this for her.

    - Janet Harrison
  • Yes so true

    - dave jones-roger
  • Thankyou for this article its so true and I wish we didn't have to send them to hospital however sometimes no matter how hard we try to convince their families to keep them here and pass away peacefully they insist on sending them anyway. I have worked in aged care for nearly 17 years and have just completed my Bachelor of Nursing 2 weeks ago and I just lost my dad to cancer after a short battle we were lucky as he got to stay in his own home and pass away peacefully with all his family around him. This was not easily achieved and quite frankly I was apalled at how hard it actually was to get the appropriate services and assistance that he needed however he was not making it easier as he was very independent. I would love to learn more about palliative care and how we can better look after our loved ones in their final days of life.

    - Desiree Pearson
  • Yes, I was in a & e with my daughter and I identified 3 of the 5 patients were inappropriate transfers from a facility while sitting with my daughter. One poor man was in his last hours. I remember implementing a program ? Title but, 2oyrs ago now. We had alreadyi Had established the practices Melissa has implemented, we also had a memory book. A photo of the resident was centre page and staff decorated, or wrote their memory- word a reflection on the page. It was not uncommon to see a staff member turning the pages from time o time

    - Mary-Anne
  • My husband passed at home last year and our family has formed a new charity that assists people to remain at home in their dying days... some families struggle with this and we aim to assist both financially and personally with care for the families and patient.. it's where my heart lies having been through it first hand.

    - Heather Roberts
  • An amazing article and this should be done in all aged care facility and also could be great when people are dying at home as this would be great for nurses that look after people in their own homes and also group homes ect.more funds should be put in place for this to happen hopefully government will read this article.

    - Vicki Glennon
  • I was very pleased to have read your article Melissa and I would like to congratulate you and your wonderful team. Keep up the great work.

    - E. T
  • I am a Registered Nurse in Perth, who has worked in Aged Care for over 20 years. It fills me with such sadness that anyone who is in Aged Care should die in an emergency centre. We talk regularly with our residents and their families and we know what they want. The vast majority want to remain with us on their final journey, cocooned in loving care, being looked after by staff who know them, in a Palliative setting. Thankfully we achieve this 90% of the time.

    - Melanie Forster

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