CareSearch Blog: Palliative Perspectives

Over the past two years, CareSearch has hosted Dying2Learn, a free Massive Open Online Course (MOOC) about death and dying. We created the course hoping we could provide a community platform for open social discussion and connection on death, dying and palliative care – something that at times can be hard to strike up a conversation about in our day-to-day lives.

Australians are not well prepared for death and there are indications that many people are not comfortable talking about death. It may be that as medical advances have improved our life span we have become less familiar with death or that as our community has changed our rituals and practices for caring for the dying have also changed. The last few years have seen an increasing interest in ensuring that dying is recognised within the community. Death education, public health promoting palliative care, death cafes, and compassionate communities are just some of the ways that people are reclaiming an awareness of, and a responsibility for, death and dying.

In my role managing two aged care homes in Melbourne, I have come across a number of challenges which needed to be overcome. I took over one home four and a half years ago and the second 18 months ago, discovering the same basic issues in each home; after the first time, the issues were relatively easy to change. Staff were fractured in the sense that departments did not necessarily rely on each other and work together, and knowledge of clinical issues was only handed over to clinical staff, not to the whole home (not an unusual happening). My idea of sharing with all staff was greeted with a degree of scepticism at first, but staff embraced it quite quickly and then started to discuss things across different departments.

For this discussion, aged care refers to the additional care required for an older person needing regular health professional input either in the community or in an aged care home.

Palliative care is, according to the WHO (World Health Organisation), ‘an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual’.

Many people spend the last stages of their lives in aged care, and for that reason Palliative Care Australia believes that end-of-life care should be recognised as core business for residential aged care.  Increasingly, aged care providers are recognising the need to ensure their workforce have the necessary skills and competencies to deliver high quality end-of-life care. Yet in spite of this recognition, access to quality palliative care services is far from guaranteed in residential aged care – particularly in rural and remote areas.  
We all want the ‘best death possible’ for our loved ones and ourselves as we enter old age. So we need to ask ourselves, what are the barriers to accessing care that can support this, and will looking at the issue from a population or needs-based policy perspective help to ensure end-of-life care becomes core business for all aged care providers?