Best laid plans reduce patient discomfort and distress
The AMA has called for the widespread use of palliative care plans to ensure residential aged care residents with life-limiting illnesses are not subject to unnecessary pain and distress.
Amid concerns that the terminally ill are often being unwillingly hospitalised, the Association has proposed that palliative care plans be widely adopted in residential aged care facilities to ensure care is provided consistent with the wishes of patients and their families.
In an updated Position Statement, the AMA warned that the acute model of care, in which priority is given to treating disease and preserving life, “does not necessarily respect the needs of patients living with life-limiting illnesses, and can impose additional unnecessary pain and distress”.
It said the palliative approach in aged care settings recognised that health care “should not be based on diagnosis alone. The aim…is to maximise quality of life through appropriate needs-based care”.
There has been renewed attention on the care provided to terminally ill patients, particularly the elderly.
The enormous cost of hospital care has increased the focus on efforts to support patients in other settings, including home and aged care facilities.
But public hospital physician Dr Karen Hitchcock, writing in the Quarterly Essay, criticised what she saw as a tendency in the health system to all-too-readily write elderly patients off.
Dr Hitchcock wrote that sometimes practitioners were overly quick to assign patient to palliative care prematurely, and said that although the goal of care directives and treatment plans – to empower patients - was morally sound, in practise it might have unintended and adverse consequences, including heightening the readiness not to treat, and playing on the desire of vulnerable patients not “to be a burden”.
But AMA Vice President Dr Stephen Parnis, an emergency physician, said research by the Grattan Institute showed that 70 per cent of Australians wanted to die at home, including in their aged care facility, and palliative care plans were a way of helping achieve that.
“Transferring residents of residential aged care facilities to acute care settings when their condition deteriorates can often impose unnecessary pain and distress,” he said. “It may also not necessarily respect the needs of patients living with life-limiting illnesses, who prefer to receive palliation within the residential aged care facility.”
Palliative care plans helped ensure aged care home staff, GPs and specialists knew when a patient was not to be automatically transferred to hospital for invasive or burdensome treatment, Dr Parnis said, adding that care should be provided on the basis of need, rather than diagnosis alone.
“The AMA would like to see the introduction of templates for palliative care plans in aged care. Palliative care plans are an excellent way to ensure that everyone involved in the person’s care follows the same agreed approach.”
In addition to helping the provision of palliative care plans, the AMA said aged care homes had a role to play by ensuring the ready access of doctors to their patients and medical files, and that staff had the right skill mix to provide quality care at all hours – something seen as important in reducing the need to transfer residents to hospital.
Published: 24 Mar 2015