Goodwin Aged Care steps up to provide proactive palliative care in-house
Goodwin Aged Care Services in Canberra has made an extraordinary effort to ensure residents achieve the best possible care at the end of life. Acknowledging that many residents want to die comfortable deaths without going to hospital, it piloted a new approach to providing specialist palliative care in-house. Palliative Matters celebrates the achievement to mark the start of National Palliative Care Week on Sunday 21 May.
There has been a stark change in demographics over a short time at Goodwin Aged Care Services in Canberra. Twelve months ago, residents who moved into the live-in care facilities stayed for more than two years before they died. Now, they stay for an average of just 18 months.
Executive manager of residential care, Robyn Boyd, says people are moving into Goodwin’s four facilities closer to the end of their lives, often with multiple chronic illnesses including dementia. Often, they need high-level 24-hour nursing care. And often their loved ones are still struggling with the idea that end of life is near.
“People are coming into care older and frailer, so really the care we are providing is a lot like end-of-life care,” Robyn says.
It’s a daunting trend that’s not unique to Goodwin, but the organisation’s response has been ground-breaking, achieving international interest late last year. Partnering with Calvary Care for Palliative Care Research and Calvary Public Hospital Bruce, it was enthusiastic about being the site for research piloting a new proactive way of delivering end-of-life care.
The pilot succeeded in allowing more people to be in their preferred place at death, reducing the number of deaths that occurred in hospital and the length of hospital stays. The results were so impressive that the concept is now being trialled across 12 residential aged care facilities in Canberra.
Speaking for the first time about Goodwin’s involvement in the pilot, Robyn says a World Health Organization quality of life assessment confirmed that residents needed the facility to be proactive in planning for death and dying.
“What our residents told us through that survey was that they weren’t worried about dying, but they were worried about pain in death and where they would die; whether they would be in their preferred place at death,” says Robyn.
“It’s something that isn’t openly discussed in aged care. People find it quite confronting, families probably more than residents.
“Our goal is to respect the preferred place of care for the resident. Residential care facilities become people’s homes, and some people don’t want to leave home and go to hospital at end of life. But if they choose to go to hospital, they can also do that.”
Goodwin is well-placed to provide end-of-life care in-house, with registered nurses providing 24-hour care across each of its facilities; something not mandated in the ACT. However, in some instances, residents needed access to specialist palliative care, to ensure appropriate symptom management. In order to provide that specialist care proactively, Goodwin teamed up with Calvary’s Clare Holland House palliative care nurse practitioner, Nikki Johnston, for the three-month trial and beyond.
Generally, a specialist like Nikki would be called to a residential aged care facility only after a resident had started experiencing symptoms. Instead, Nikki introduced palliative care rounds, conducted with staff, in order to identify residents who were likely to die in the next six months.
Holding case conferences, documenting each resident’s end-of-life wishes and planning for them was then a priority. Nikki identified the symptoms residents were likely to experience and prescribed medication so it could be obtained well in advance. She also trained clinical staff so they were confident to administer the medication, if and when it was needed, which was key to reducing avoidable hospital admissions.
“Goodwin’s enthusiasm for being involved in the pilot trial was just phenomenal,” says Nikki.
“The research team met with them one day, and we were starting the work the next.”
She says residential aged care staff, from the carers up, work “incredibly hard”, so it was wonderful to see the gains in morale that came with the opportunity to upskill.
“They still tell me how rewarding it is. It is incredibly hard, working in aged care, and [Goodwin staff] lapped up the opportunity to learn and contribute to residents at the end of life. They found it rewarding, which was great. And we need to value them because this work is really important for older Australians.”
Robyn says having residents, family members, general practitioners and staff involved in case conferences has improved outcomes for families as well as residents.
“Having palliative care needs rounds to discuss goals of care and what residents wanted at end of life opened the doors to a lot of things,” says Robyn.
“Firstly it brought the discussion out into the open. Often in residential aged care, end of life it is very emotional and distressing for families because they are losing a loved one. Sometimes that can then turn into: ‘What has gone wrong? Why is my mother dying? And why hasn’t something been done about that?’.
“It is almost like something has gone wrong and has made this happen, rather than it being a natural part of life.”
She says when families have to make decisions on behalf of a loved one, it is far less stressful when their wishes are known.
“When family hear a resident’s goals and our nurses hear them too, everyone is on the same page and we can develop a care plan to ensure we follow their wishes to the letter.”
She said one resident who died recently had made it clear she’d “had enough”; “I’ve had my time and I’m ready now”.
“She didn’t want any intervention or to be transferred to hospital. She wanted to die at home and that was our residential aged care facility,” says Robyn.
“When the time came, in a matter of weeks, the care provided was as she wanted and the family was aware of what was happening, every step of the way. That was what we call a positive experience because everyone knew what was happening and what her wishes were. And we were able to uphold them.”
Robyn says Goodwin will continue to research palliative care models and take whatever next steps are required to cater for the growing proportion of residents requiring sub-acute care.
“We are always looking at international models and research to inform where we should go in terms of providing palliative care, and what that care looks like,” she says.
“We need to continue working in that space because our demographic is still changing. We know that in the future our care provision will look different to today’s.”
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