SA pilot highlights need for training in end-of-life care

A South Australian pilot project has highlighted the benefits of taking comprehensive and appropriate measures to improve palliative care in residential aged care.

As part of National Palliative Care Week 2023, Flinders University palliative care experts have called for more focus on preparing aged-care staff, and family members, based on the results of the innovate pilot project.

The ‘Comprehensive Palliative Care in Aged Care Measure’ — a Commonwealth initiative aiming to improve access to quality palliative and end-of-life care for older Australians living in residential aged care — was adopted in various models at seven not-for-profit Eldercare aged care facilities in metropolitan Adelaide and 15 publicly funded residential aged care homes in regional SA.

The models of palliative care adopted by each site included palliative care Needs Rounds, workforce education and training, traineeship model, specialist palliative care in-reach support and grief and bereavement support for families.

Professor Jennifer Tieman and Dr Sara Javanparast, from the Research Centre for Palliative Care, Death and Dying (RePADD) at Flinders University, were invited by SA Health to evaluate the project.

The evaluation work has provided great insights and learnings about palliative care initiatives in aged care setting, they said, including that any new initiative requires strong engagement from the sector to “make it work”.

“We know that aged care is a complex setting facing many challenges including workforce shortage,” said Javanparast, from the College of Nursing and Health Sciences.

“Any new initiative requires strong engagement with the sector to ensure they are aware of the value that the project adds to them, their facilities and to residents.

“Secondly, there is no ‘one size fits all’ model, with each site in the trial subject to their organisational capacity, infrastructure, geography and access to financial and human resources.”

For example, while participants found the palliative care model is ‘very positive’, ‘respectful’, ‘really beneficial’, and ‘professionally run’, each site adopted a slightly different version to meet their needs.

“Thirdly, as reported by the Royal Commission into Aged Care Quality and Safety, aged care is suffering from an under-educated and under-skilled workforce in palliative care,” Tieman explained.

“However, our evaluation has shown the importance and effectiveness of palliative care training and mentoring to improve identification and management of palliative care needs.

“Staff shared how much they appreciated the education sessions and saw palliative care as an area of nursing that needs to be done well.

“Due to high turnover of workforce in aged care, continued training, refreshing courses and on the job mentoring are critical.”

Tieman added there is a large knowledge gap in how to communicate with residents and families about end of life, death, loss and grief.

While this project was restricted to only a small number of metropolitan and regional aged care facilities, the RePADD review emphasised that equitable access to specialist palliative care expertise including nurses and medical practitioners is critical to ensure all Australians living in residential aged care benefit from high-quality palliative care.

“This, indeed, requires broader policy commitment and investment,” Tieman stressed.

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