End of life care at an Australian Government funded rural aged care facility in Victoria is supported through education and consultancy from the local and regional palliative care services funded by the State Government.
A patient with multiple morbidities including prostate metastases and renal failure had been an acute patient attending Colac Area Health’s hemodialysis unit. He was admitted to Corangamarah Residential Aged Care in Colac with a terminal diagnosis and his condition soon deteriorated as the dialysis was not working.
Corangamarah’s Care Co-ordinator Daniel Tout and the nursing staff discussed his advanced care plan and end of life care with the patient and his family. The resident wanted to be kept comfortable until the end and to not be in pain. The family wanted to be advised of any changes in his condition, even if it was confronting. Together it was agreed that pain management and communication were the goals of care.
A fortnight after admission Corangamarah staff recognised that the pain management strategies were no longer effective and a case conference agreed to implement the end of life pathway in accordance with the goals of care. The staff, Ali Weedon, palliative care nurse for the Colac Area Health’s community nursing division, and the patient’s GP were called in to provide the specialist services required and the family agreed that the time had come to change the medication and to start saying goodbye.
The care team also had a phone conference with a Palliative Registrar at Grace McKellar Centre in Geelong and in consultation with the family they agreed to cease all therapeutic medication and focus on the pain management medication, suggested and previously used by Corangamarah in end of life care, that would be more effective in providing comfort.
The resident’s request to be pain free had been met, the family was kept informed throughout the process, and was grateful for the support and clarity given by the team.
This case inspired Corangmarah’s staff to promote palliative care and it held an educational lunch for local GPs during National Palliative Care Week in May, to update them on current end of life medication and treatment issues.
The 75-bed Corangamarah Residential Aged Care in Colac is two hours from Melbourne. It works with the Colac Area Health Service, in particular with Ali Weedon the palliative care nurse, and accesses regional training support via the Palliative Care in Aged Care Link Nurse Program. More specialised medical expertise – over the phone in an emergency – comes from the Barwon SW Regional Palliative Care Consortium an hour away in Geelong.
The Palliative Care in Aged Care Link Nurse Program provides a service that educates the staff at Corangamarah and supports end of life decision making. Most importantly the residents are provided with care that is contemporary and collaborative.
According to Daniel, the Palliative Care in Aged Care Link Nurse Program is very successful.
“The program uses the Palliative Approach Tool Kit promoted by the Australian Government. The Tool Kit is comprehensive and facilitates a consistent approach in providing palliative care and quality end of life care. The program demonstrates the importance of how to work collaboratively in a multidisciplinary environment.”
Part of Daniel’s role is to have a conversation with every new resident and family about advance care planning. He believes: “It is best to discuss this earlier rather than leaving it to the time when end of life care is needed”.