Enhancing palliative care in rural Australia: the residential aged care setting
Geoffrey Mitchell A D , Caroline Nicholson B , Keith McDonald C and Anne Bucetti AA Room 407, Building 12, University of Queensland Ipswich Campus, Salisbury Road, Ipswich, Queensland 4035, Australia.
B Mater Health Services, Level 2, JP Kelly Building, Raymond Terrace, South Brisbane, Queensland 4101, Australia.
C Murrumbidgee General Practice Network, Level 1, 13–15 Kurrajong Avenue, Leeton, NSW 2705, Australia.
D Corresponding author. Email: g.mitchell@uq.edu.au
Australian Journal of Primary Health 17(1) 95-101 https://doi.org/10.1071/PY10054
Submitted: 31 August 2010 Accepted: 10 February 2011 Published: 16 March 2011
Abstract
The delivery of palliative care in residential aged care communities is challenging, even more so in rural areas due to workforce ageing and shortages. The objectives of the present study were to: (i) assess the needs of, and quality of palliative care delivered to residents of 16 residential aged care facilities in rural southern Australia; and (ii) identify the needs of care staff to facilitate the delivery of quality palliative care. A cross-sectional survey of all residents, assessing the degree of functional limitation, stage of palliative care, and the presence of several quality indicators was conducted. Separate focus groups of care staff and relatives of residents sought information on the quality of care delivered, perceived strengths and weaknesses of the care delivered, and education and training needs. Quality palliative care in residential aged care facilities (RACFs) is hampered by workforce shortages, with low ratios of registered nurses, limited access to general practitioners after hours, and some communication difficulties. Some staff reported low confidence in technical and psychosocial aspects of care, especially for relatives. Relatives described mostly appropriate care, while acknowledging workload constraints. Most residents whose condition was unstable, deteriorating or terminal received advance care planning, though family expectations and unwillingness to discuss end-of-life care did tend to delay planning. Unstable residents with a reasonable prognosis were more likely to be transferred to hospital than terminally ill residents. Palliative care in participating RACFs appears to be adequate. Provision of targeted education for health care providers and implementation of protocols for advance care planning and end-of life care pathways will enhance this care.
Additional keywords: advance care planning, end of life care pathway.
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