A Good Death: Does the model of End of Life Care Developed in Australian aged care homes present opportunities for developing good practice in the United Kingdom.
This report is the result of a scholarship award that enabled the scholar to visit Australia, explore care practices being developed to improve end of life care for residents living in aged care facilities and to consider how they might be applied to improve end of life care in care homes within the UK. This report provides a description of lessons learnt from The Good Death Project in Australia with an analysis of how similar practices could be developed in the UK.
The world’s population is increasing in age and numbers and the provision of healthcare for this growing population is becoming an important worldwide consideration. Within the UK, planning to provide care is raising a number of issues for individuals, families, healthcare providers and organisations. Bupa Care Services provide long term care both in nursing and residential homes in the UK and in Australia in aged care facilities.
In April 2015 the scholar visited Sydney and met with the Head of Bupa Dementia Care Services, Margaret Ryan and Bupa Learning and Development nurse Steve Wilbin. With assistance and guidance from Margaret Ryan, visits were arranged to two Bupa aged care facilities, one in Cardiff New South Wales and the second in Geelong near Melbourne.
The main focus of the visit and this report was the implementation of The Good Death Project in residential aged care facilities. The project was funded by the Australian Government Department of Health and Ageing. The scholar also visited the North East Valley Division of General Practice in Melbourne to explore how the Good Death Project was developed and gain an insight from Diana Cooper, the National Training Co-ordinator, into the challenges and outcomes of that project.
Funding has now been provided by the Australian Government to help deliver palliative care and advance care planning in residential and community aged care across Australia in a new project based on the work of Assistant Professor Deborah Parker at the University of Queensland. This project is called Decision Assist.
Australia has identified the need for improving end of life care delivery in aged care facilities. The Government is now planning future care needs in order to deliver improvements through Government funded projects across all of Australia’s states and territories. Australia is developing an evidenced-based framework to co-ordinate a multidisciplinary approach to improving palliative / end of life care in aged care facilities.
The South Australian Parliament in1992 stated,
‘the way we care for the dying and those who are in great difficulty as they come to death really is a sign or a symbol of the sort of society we wish to be, or wish to be known to be’.
Australia is developing policies to ensure community end of life care is collaborative, evidence–based and fit for purpose through joined up approaches in delivery and practices.
In the UK, end of life care is a priority for health and social care providers. Care homes are places where people live and where many will die. Many homes have excellent skills in supporting end of life care but in society there is still a real taboo in talking about death and dying.
The Gold Standards Framework (GSF) for care homes has been recommended as good practice since 2008 in the Department of Health End of Life Strategy. The implementation of the framework has varied across the country with no national guidance on implementation or facilitation.
A good death in a care home setting has been described as one where there has been continuity of care and effective team work and communication about care planning. This planning should begin when the resident is admitted and develop over time.
The provision of palliative care for older people is in a state of transition and to achieve quality palliative care will require attention to all levels of the health and social care system. It is suggested by many scholars working in elderly care that long-term care facilities will become the hospices of the future, caring for older people with chronic conditions with a long trajectory to death, the most common being dementia (Abbey et al, 2006).
Changes to improve care at end of life in England have recently been proposed in the publication by The Leadership Alliance for Care of Dying People. “One Chance to Get it Right“(2014). Following concerns by bereaved relatives, a review of the Liverpool Care Pathway was commissioned by the Minister for Care and Support, chaired by Baroness Julia Neuberger. The independent review ‘More Care, Less Pathway’ articulated a vision of what good end of life care should look like. The resulting document published by The Leadership Alliance for the Care of Dying People ‘One Chance to Get it Right’ formed five priorities for care. It was accompanied by a set of commitments to ensure care is delivered in accordance to the dying person’s wishes that are reviewed and revised accordingly. The Liverpool Care Pathway has been removed from use and work is being undertaken in different areas of the country to develop documentation (not necessarily a pathway document) to assist with end of life planning and to provide person-centred, co-ordinated care at end of life.
NHS England, Action for End of Life Care 2014-16 and the Nice Quality Standard (2011) also recommend a person-centred holistic approach to meet the needs of the dying person and their families / carers, with care to be co-ordinated over 24 hours with palliative specialist services offering support. The recommendations indicate that the workforce delivering this care should be multidisciplinary and sufficient in both numbers and skill mix to provide high quality care and support.
Action for End of Life 2014-2016, recommends that staff receive education, support and training to address the five Priorities of Care for the dying person as set out in ‘One Chance to Get it Right’ document. Commissioners of services are to ensure that considerations include attention to end of life care. The Action for End of Life Care document highlights a specific focus for people who have dementia and people with severe frailty; many of whom will be living in care homes. GPs are now working closer with care homes with each person over 75 years of age having a named GP. Many GPs are now also using emergency health care plans and advance care planning to record the wishes of elderly residents.
Services are being developed by Governments in both Australia and the United Kingdom to meet the needs of an ageing population.The elderly and the frail are our society, our parents, grandparents, friends and neighbours. They are every one of us in the not to distant future. We must plan for a future with the aim of providing services within the community to include care homes that are well planned and coordinated with a multidisciplinary team approach and a well trained work force.