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400837 Palliative Care Provision in Aged Care in Australian Health Care Sector Assessment Answer

Unit Code: 400837 

Unit Name: Health and Socio-political Issues in Aged Care

2.4.2 Analytical Paper

Weight: 60%

Type of Collaboration: Individual

Format: All assignments are to be typed.

Typing must be according to the following format. 

Required format Length as designated by assignment

3 cm left and right margins, Double Spaced

Font: Arial or Times New Roman

Font size: 12pt

All borrowings from other sources must be properly referenced and a reference list must be included at the end.

Length: 3,000 words

Curriculum Mode: Report

Aim of assessment: The purpose of this analytical paper is to show your understanding of current issues in providing palliative care in residential aged care.

On successful completion of this assessment task students will have met the following learning outcomes:

1. critique models of health service delivery for older people, including models of wellness, user-pays, case management, and active ageing (WHO);
2. demonstrate an understanding of contemporary aged care issues from political, philosophical, legal and ethical positions;
3. critically discuss strategies for reform in the delivery of aged care services that take into account all stakeholders.

Details
In this assessment task you are required to write an analytical report that:
– explains palliative care provision in residential aged care
– critically discusses advanced care directives in residential aged care
– considers strategies that may improve the provision of palliative care in residential aged care In this paper you should include:
– A discussion of what palliative care and a palliative approach is and explain how it is applied in residential aged care
– A discussion of advanced care planning and advanced care directives
– A discussion and critique of the issues in advanced care planning and applying advanced care directives in residential aged care
– Identify strategies to improve palliative care service provision in residential aged care
– Your paper must include references to the literature
– You can use headings in an analytical paper

Answer

Health and Socio-political Issues in Aged Care – Report

Executive summary:

Through promotion of palliative approach, positive outlook towards dying and death among residents and their families is ensured by the support of care provision team. The paper analyses about application about palliative care provision in aged care in Australian health care sector. Advanced care planning has been demonstrated to have effective role in improving care outcomes and minimise pain among aged care residents when designed in line with advanced care planning. Further report has critically evaluated the terms and application of a number of elements such as wellness, case management, basic health, user-pays and active aging as proposed by World Health Organization in improving care outcomes of people. Different strategies that have been proposed in the report are active involvement and information sharing between carers and clients, data maintaining of client, right information at right time, advanced care planning through advanced care directives and staffs training and development. 

Introduction:

The paper undertakes a study on palliative care provision in aged care in Australian context. In the paper, different key areas such as palliative care approach, advanced care planning and advanced care directives have been analysed in residential aged care. The paper further demonstrates although different initiatives and programmes have been designed and adopted in residential aged care with an aim to improve care outcomes and minimise pain, a number of elements have not been achieved such as wellness, case management, basic health, user-pays and active aging as proposed by World Health Organization in improving care outcomes of people. Different strategies also have been proposed with an aim to develop delivery of aged care services. 

Palliative care and palliative approach 

Palliative care according to WHO is an approach to develop the standards of life of the health care users and their relatives experiencing issues linked with life endangering health issues or life limiting issues through management or preventing of diseases by assessment, early recognition and addressing pain and other health related problems encompassing physical, spiritual and psychological, that the patients have been suffering from (World Health Orgnaization, 2019). Palliative care is delivered by community, public, independent and voluntary organizations functioning in partnerships to provide integrated healthcare services. Palliative care offers end of life care to all patients and their families which is the core element of all health care services. Palliative care is not only restricted to terminal stage care or end of life care but it offers care to all individuals living with any health care problems and at any stage of the illness as recommended by World Health Organization, (2012). However, underlying philosophy of palliative approach is open attitude towards death and dying. 

A palliative approach should offer to the patients with different elements such as dignity, autonomy, respect and comfort, evidence based treatment options and open and honest information sharing on health issues and treatment available. The particular approach also should deliver methods and tools to manage pain and other symptoms that causes suffering, improve quality of life as well as respecting the cultural and spiritual needs of patients. Palliative care approach considers dying as a normal life process which can be applied in combination with other therapies especially that may be a lifelong sufferings. Death is neither delayed or push forward but rather it makes effort to improve life quality of patients.  Focus of care alters in palliative care from cure to care as it includes relieving any pain or distressing situation while improving the standard of life and supporting families. When cure of the underlying diseases is not possible to achieve, support and assistance can be provided to the patients so that their quality of life can be improved until they die (Broad, et al., 2013). 

Through promotion of palliative approach and positive outlook towards dying and deaths between residents and their families and care provision team supports them recognition of care users wishes in the end of life care. Palliative approach puts focus on positive outlook and active comfort care by minimising pain and distress that make the care users and their families realise that they are immensely supported throughout the end of life process.

Palliative approach is applied residential aged care

Australian Palliative Residential Aged Care (APRAC) has been putting effort so that support and guidance can be offered to all the aged health care users in 3000 aged care facilities across the country. Guidelines design in line with Goal Two of the National Palliative Care Strategy are available for all sections of palliative  approach are integrated to early diagnosis, management or minimisation of  physical suffering as well as meet psychological, cultural and spiritual needs. The guidelines have been developed with an aim to enhance effectiveness and standard of all care services in Australia’s palliative care settings (Higginson, Sarmento, Calanzani, & H, 2013). These guidelines further make effort by establishing improved standards in policy, practice, community improvement and research and advocacy to ensure ALL individuals in Australia receive palliative care facilities. 

Figure: Palliative care in aged care during 2016–17

Palliative care in aged care during 2016–17

Source: (Butler, 2017)

Studies have demonstrated increased number of people dying in Residential aged care facility in Australia and therefore application of palliative approach has improved care to both residents as well as their family members. Most of the residents have been experiencing psychological, emotional,  physical and social issues. Residents also may require palliative approach when they are approaching towards their death because of their age. Goals of the evidence based recommendations are aiming at assisting and supporting team members in the aged care residences in implementing palliative approach (Lam, et al., 2018). The guidelines encompasses all needs of the care users ranging from physical symptoms to mental distress to tackle the family members’ reactions. 

Figure: Palliative care status aged care, remoteness area, 2014–15

Palliative care status aged care, remoteness area

Source: (White, Tilse, & J, 2014)

All the Residential aged care facility apply approach in guiding the clinical teams for supporting the residents and their family members. Aged care team not only identifies their physical, spiritual, psychological and social needs but meet those by prescribing and administering various medication to alleviate their pain as well as provide support to meet their psychological needs such as respect, dignity and values. 

Advanced care planning 

Advanced care planning is a process in which the multidisciplinary team shares information and the treatment process, potential effectiveness of the treatment and benefits of the treatment as well as outcomes of different interventions with residents’ aged person’s family (National Advance Care Directives Working Group, 2011). Aged person’s family similarly share their hopes, values, goals as well as what they think about child experience. Advanced care planning aims at achieve overall benefit of medical care and the interventions that are provided to the care users. Advanced care planning provides guidance about the current treatment as well as future treatment in case health condition deteriorates. Information sharing and reflection are the two key elements of advanced care planning (Department of Health and Ageing, 2010). 

Advanced care planning is a long term process and is not an event that start and finish within very short period of time. Advanced care planning is effective in providing residents and their family members’ satisfaction and better end of life care (White, Tilse, & J, 2014). An advanced care planning is an interactive process in which communication is carried out between aged care residents and aged care team. The aim of this communication process is to obtain wishes of residents in palliative care home regarding their treatment decision which is usually included in the treatment giving process in their end of life care, to improve their liberty and to encourage decision making when resident is found to be incompetent in participating in the process (Bradley, Woodman, Tieman, & Phillips, 2014). However advanced care planning must not be a formal or legal process but rather it include communication with the resident in the palliative care home and their family members as communication is the key to advanced care planning. 

Advanced care directives

Advance care directives supports people in planning further when they are incompetent in their decision making ability, so that they can either live well or die while promoting dignity and individual values. Nonetheless, adoption of Advance care directives is low in Australia (Candib, 2010). In the wider area of advanced care planning, Advance care directives must be taken into account so that future care requirements can be made and health condition can be improved when residents is incompetent in making or communicate decisions (Silvester .W, Fullam, & Parslow, 2013). Through advanced care planning, residents share their values, beliefs and preferences in order to guide designing future care planning and future decision. Advanced care directives guide nurses, families and other health care professionals in making decision in line with the resident’s wishes when residents are incapable in making their own decisions.  

However an advance care directive is inefficient in including direction all the potential decisions that can be taken for the betterment of quality of life or meeting the wishes about the care planning of the residents. Substitute decision maker is the one who accepts the responsibility and they are appointed to make decisions on behalf of the residents who has incompetent in making his/her own decisions. In line with National Framework for Advance Care Directives the documents is aimed at guiding and informing healthcare providers and legislators. 

Advanced care planning and application issues of advanced care directives

A number of key stakeholders that encompasses health academics, the Australian Law Council (ALC), consumers and the Australian Medical Association (AMA) are engaged in advanced care planning. Only certain provinces of Australia have their own legislation regarding Advanced care directives those are Victoria, South Australia, Queensland and Western Australia. However in other provinces of the country common law is likely to be involving in this areas since they do not have specific legislation regarding Advanced care directives. Additionally there is no nationwide accepted definition of Advanced care directives that are legally enforced. 

Advanced care directives can be equally established in different states of the country by a colon law that has legal bindings which also could be transferred to other states crossing state boundaries. Medical professionals regardless of any specific state boundaries possess right of dismissing document by disagreeing the directives. AMA has provided a position statement against Advanced care directives in 2013 that proposes the major body is legally concerned may enforce the health physicians into a circumstance that according to her or him is not happen to be a positive clinical care. Australian Medical Association does not provide any legal bindings to the health physicians may have their justified disapproval (Harrington, Williamson, & Goodwin-Smith, 2018). 

According to the report of WHO, basic health services to an acceptable standard is still not delivered to the world many countries that affects poorest people. On the other hand, government also has been experiencing dilemma because of the underfunded health systems. Service costs in the health and social care sector in the form of user charges act as barrier in accessing quality care. Another barrier to provide standard care is shortage of resources in the health care sector . However researchers have opined that users charges may generate extensive resources which will support in providing standard care services to the health care users. In contrast, others have focused on its adverse impacts such as equality as poor will not be able to provide user pays for their services are likely to obtain inferior quality care. In support of negative effects of users pays, a wide number of international campaigns have advocated the elimination of this fees particular on the primary care services (World Health Organization: Bulletin of the World Health Organization, 2019). 

Healthy aging according to World health organization is the process of developing and maintaining efficiency to function that facilitates older people’s wellbeing (Future, 2016). Behavioural, wider environmental such as lifestyle and other aspects that beyond individual’s control and genetic factors are the basis of healthy aging. Australia has been experiencing immense economic challenge in improving health of increasing number of aged persons (AIHW Australian Institute of Health and Welfare, 2017). However healthy aging faces certain challenges that include a wide number of care services to collaborate and partnership working between aged care and support system for older Australians, minimised informal care, shortages of workforce, quality of life problems in the aged care residents  that may lead to poor mental health status among care users. Although successful aging models are prominently positioned, they have been argued by researchers as they found to aim at individual success rather than denial of social and structural aspects that affect aging.

Concept of wellness is that it is a holistic approach and there should not be an illness, both are essential. Wellness is not only restricted to absence of adverse elements such as diseases and health issues but also occurrence of positive elements such as happiness and physical health. However wellness in the context of aged care could not be achieved in true sense. With increasing critical illness, chronic health conditions and increasing life expectancy, not only Australian but all health care systems have been experiencing challenges in meeting health needs of clients. In regards to aged care as defined by WHO could not be achieved as diseases and health issues could not be addressed despite a number of better health services are being provided in aged care as well as improving happiness or physical health also have been ineffective (Parker & Clifton, 2016). 

Case management has been defined as a well-structured process of planning, coordination of service, referral or monitoring through which multiple needs of care users can be achieved. Case management model has not been adopted or studies in Australia although there is needs for effective care models in improving health care facilities in aged care. Case management model has been found to have been applied successfully in community care despite there remain little evidence of adopting the model in other sectors. Case Management Model in aged care facilitates clients enjoy continuity of care. Although a wide array of literature prevail on case management in different forms, the descriptors of case management usually are non existent or are ineffectively analysed paired with constructs and mixed concepts. Additionally, case managers needs to have relevant training in particular skills such as negotiation and budget management. Additionally efficient and trained case managers involved in the multidisciplinary team of care may raise care cost that again may be a challenge to the health care system. 

Strategies to improve palliative care service 

Different strategies can be adopted with an aim to improve palliative care service provision in Australian aged care institutes. 

Active involvement and information sharing between carers and clients: In line with a wide number of research studies and evidences of involving clients and carers in decision making and integrating the care planning is the key tool to improve health care outcomes as well as meeting client’s wishes regarding their the spiritual, social, psychological and physical needs. Health outcomes can be maximised with multidisciplinary teams’ involvement in the care provision planning and act and result in meet the needs of care users and their family. 

Data maintaining of client’s satisfaction and act on those data: Assessment ad monitoring of client’s expectation and meeting those needs found to have better outcomes on medical performance and maintaining relationship between carers, clients and their families. Regular assessment and information maintaining facilitates in evaluation of the data to identify whether client’s needs have been achieved or not or if the health care programme that has been designed for a particular client has been effective in delivering appropriate care or not (Tuckett, et al., 2015). Access to information, communication, availability and staff skill and competence, care management and effective pain management are the key factors that have found to have positive influence on carer and client satisfaction in the palliative care. 

Cares and clients are supported by right information at right time

Meeting needs of carers and clients are supported by right information at right format and at right time. Information about client health problems, treatment and care, symptoms and progression are sought by the carers in aged care (Jones & Moyle, 2016). Research studies have constantly supported high quality information as the key to improve care and treatment for the carer of people especially who have been suffering from potentially fatal diseases. Information facilitates carers in identifying stage of illness and individual needs that help them develop care planning accordingly (Butler, 2017). However the information that are provided to the carers should be detailed and honest as those are basis for making justified decision about the treatment process to the aged residents. 

Some of the clinicians have stated that their clients may lost hope if they are fully made informed about the prognoses. However, information about the prognosis has resulted in improved satisfaction with care and minimised depression level. A sense of hope also can be identified if carer find that their prognosis of inaccurate. It is very crucial that carers respond to individual needs of the clients based on how much information they have got and in what format. Residents may have different expectations based on their cultural differences, experience, role of their family, choice and linguistic factors in sharing and receiving information.

Better client experiences can be achieved through advance care planning

Advanced care planning is the process of future care planning in line with aged care residents expectations, health needs, values, beliefs and preference so that those information can be used for decision making when the care users is incompetent in end of life decision making in future. Well designed and formal care planning are conducted in aged care, health or institutional care setting followed by diagnosis of life taking diseases. Advanced care planning is made to develop an integrated, multidisciplinary and partnership working between carers and clients with an aim to improve health outcomes and minimise pain (Australian Health Minister’s Advisory Council, 2011). 

Advanced care planning has been found to minimise risk of receiving irrelevant treatment and access care and treatment within their preferred place. Through advanced care planning care quality can be improved as well as it enhances client’s autonomy by minimising anxiety, pain, depression and anxiety through effective communication between carers, clients and health professionals. 

Training and development of carers: Aged care institutions should take initiatives in developing skill and competence in making advanced care planning, case management, share and maintaining information and design care panning following guidelines of advanced care directives so that aim of these programs and policies can be met. Additionally, maintaining and following information will facilitate carers met clients expectations, values, health need and preferences, especially when they incompetent in making their own decisions.

Conclusion:

Different strategies such as advanced care planning and application of advanced care directives, information sharing and maintaining, active involvement of carers, clients and their families and case management have been identified to be key strategies in improving  delivery of aged care services. Hence all the key stakeholders such as carers, health professionals in aged care, clients and their families should be involved in order to achieve higher care outcomes in residential aged care. 


References

AIHW Australian Institute of Health and Welfare. (2017). Older Australia at a glance. Web report at https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance . Australia: AIHW Australian Institute of Health and Welfare.

Australian Health Minister’s Advisory Council (Clinical, Technical and Ethical Principal Committee). ( 2011). A National Framework for Advance Care Directives: Australian Health Minister’s Advisory Council. Canberra: Australian Health Minister’s Advisory Council.

Bradley, S., Woodman, R., Tieman, J., & Phillips, P. (2014). Use of advance directives by South Australians: results from the Health Omnibus Survey Spring 2012. Med J Aust, 201(12), 467–69.

Broad, J., Gott, M., Kim, H., Boyd, M., Chen, H., & Connolly, M. (2013). Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics . Int J ublic Health, 58(2), 257–67.

Butler, J. (2017). Palliative care in residential aged care: An overview. Australasian journal on ageing, , 36(4), 258-261.

Candib, L. (2010). Truth telling and advance planning at the end of life: Problems with autonomy in a multicultural world. Fam Syst Health, 20(3), 213–28.

Department of Health and Ageing. (2010). Supporting Australians to Live Well at the End of Life. Draft National Palliative Care Strategy 2010. Canberra: Australia: Department of Health and Ageing.

Future, V. V. (2016). Accessed at https://www.planning.vic.gov.au/land-use-and-populationresearch/victoria-in-future-2016. Australia: VIF Victoria in Future.

Harrington, A., Williamson, V., & Goodwin-Smith, I. (2018). Understanding the Diverse Forms of Spiritual Expression of Older People in Residential Aged Care in Australia. Journal of religion and health, 12(1), 1-12.

Higginson, Sarmento, .., Calanzani, N., & H, B. (2013). Gomes B. Dying at home – is it better: a narrative appraisal of the state of the science. . Palliat Med, 27(12), 918–24.

Jones, C., & Moyle, W. (2016). Staff perspectives of relationships in aged care: A qualitative approach. Australasian journal on ageing, 35(3), 198-203.

Lam, L., Ansari, A., Baquir, P., Chowdhury, N., Tran, K., & Bailey, J. (2018). Current practices, barriers and enablers for advance care planning among healthcare workers of aged care facilities in western New South Wales, Australia. . Rural & Remote Healt, 18(4), 12-34.

National Advance Care Directives Working Group. (2011). A National Framework for Advance Care Directives. . Canberra: Australian Health Ministers’.

Parker, D., & Clifton, K. (2016). Knowledge into Practice: Improving advance care planning and palliative care for older people in Australia. International Journal of Evidence-Based Healthcare, 14(4), 203.

Silvester .W, Fullam, R., & Parslow, R. (2013). Quality of advance care planning policy and practice in residential aged care facilities in Australia. BMJ Support Palliat Care, 3(1), 349–57.

Tuckett, A., Parker, D., Clifton, K., Walker, H., Reymond, E., Prior, T., . . . Glaetzer, K. (2015). What general practitioners said about the palliative care case conference in residential aged care: An Australian perspect Part 2. Progress in Palliative Care, 23(1), 9-17.

White, B., Tilse, C., & J, W. (2014). Prevalence and predictors of advance directives in Australia. Intern Med J, 44(1), 975–80.

World Health Organization: Bulletin of the World Health Organization. (2019). Bulletin of the World Health Organization. Retrieved from: https://www.who.int/bulletin/volumes/86/11/07-049197/en/. Australia: World Health Organization.

World Health Orgnaization. (2019). WHO Definition of Palliative Care. Retrieved May 17, 2019, from https://www.who.int/cancer/palliative/definition/en/



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