Monash Health in partnership with Regis has been awarded an ARIIA grant for their project ‘Improving palliative and end-of-life care, for people living in residential aged care' by embedding specialty knowledge in hospital in-reach programs.
As a person advances to the final phase of life specialty palliative care provides symptom control, alongside psychological, social and spiritual support.(1,2) For residents of residential aged care facilities (RACF), palliative care is sometimes too late or not at all with significant variation of care. (3–5) Ideally, residents at end-of-life should be cared by community palliative care (CPC) services. Barriers exist to timely referral and access to CPC; for example, RACF staff and community providers lacking palliative care knowledge, result in poor identification of end-of-life needs. Barriers are further exacerbated by a complex, fragmented healthcare system where escalation and referral pathways are ill-defined. (6,7) RACF tend towards an acute medical model. (4) E.g. to treat symptom exacerbation present during the terminal phase, emergency department (ED) presentations are common, however, could be avoided with palliative support. (8,9) Inappropriate ED presentations cause unnecessary resource utilisation and patient and family distress. (10) Others in the community are managed by hospital-run hospital-in-the-home (HITH) or residential in-reach (RIR) services, who, while treating many patients at end-of-life have limited training in providing terminal care. (11)
This project will trial an embedded specialist palliative care (PC) nurse within RIR/HITH programs to assist in overcoming these challenges.