Baptcare-Westhaven Community, Vic - Palliative care program

Dying with dignity, home becomes a choice

Westhaven Community has been awarded a Better Practice in Aged Care Awards for its palliative care program. This is a totally resident-focused program and based on the belief that all residents have the right to die in comfort and dignity in the place of their choice and to have someone with them when they die. There is also a firm belief and a management commitment to schedule a full review of the care and circumstances surrounding each resident who has passed. This gives the service a unique opportunity to learn from each resident and to evaluate and further develop its palliation program.

There is a multi-disciplinary approach to palliative care at Westhaven, with involvement from nursing staff, medical practitioners, hospice staff, pharmacy, physiotherapy, aromatherapy, music therapy and massage; as well as the family and resident. The relationship developed between the Westhaven care team, the local hospice service and the local acute public hospital is unique and not only ensures care consistency but also ensures residents' choices are known and where possible, met.

Palliative care and end of life decisions and choices are talked about very early in the admission process in an appropriate and sensitive manner. Effective communication is considered the key most important factor for all areas of care at Westhaven, not least around the issues of palliation. This means that palliation for residents at Westhaven is about a gradual escalation of support and comfort measures, increasing continually until end of life. As more interventions and support services are required to ensure comfort, they are slowly introduced so that the care from admission through to end of life is as seamless as possible and all parties are informed, communicated with and assisted with the decisions necessary at this time.

Education is key to the program, including:

• education and training in using syringe drivers for optimal pain relief. This enables residents to remain in the home to receive adequate pain relief
• training in sub-cutaneous fluid replacement to ensure resident comfort and to keep residents in the home rather than having to transfer them to hospital for fluid replacment. This intervention may also give relatives time to consider care options in the case of sudden illness (severe stroke for example) and reduce the need for hospital admission when death is imminent
• staff also receive extensive training in assessing pain, developing pain management plans (in consultation with the resident and health care team) and evaluating pain relief measures; as well as complementary therapies for those residents who may use this in conjunction with medical treatments.

The staff make special efforts to ensure those residents without family are cared for and not alone. Management have a policy that extra staff can be rostered on duty to stay with a resident if no family is available or if a family or resident require extra support during that time.

The clinical nurse specialist meets with the resident's relatives and friends following death to support them during the grieving process and to then gather their feedback on the palliative care program.

Staff almost always attend residents' funerals and a memorial service is held in the home for other residents to grieve and remember those who have died. Feedback from residents and relatives has been overwhelmingly positive about the sensitive response by staff to the needs of residents in the terminal stages. The program's effectiveness is demonstrated by the number of cards and letters from families thanking the home for making the palliative care process comfortable and dignified. Current residents have also commented that they feel confident that their own passing will be comfortable and in the familiar surroundings of their home as they have seen this to be the case with other residents at Westhaven.

Staff can debrief at a formal session held by the clinical nurse specialist and chaplain. They can also meet privately with the chaplain. Staff say they feel confident that they can provide excellent palliative care and are able to give residents and their families a peaceful and dignified death. Westhaven management believes that a successful palliative care program within an aged care setting stimulates staff to think more about what they do every day. It enhances their role as significant care givers; adds another dimension to their already important role and challenges their thinking. Overall, staff working together with the aim of provided expert end of life care can make all other aspects and levels of care more considered.