Carol

Building residential aged care capacity to deliver a palliative

approach

July 2014

Carol BarbelerPalliative Aged Care Resource Nurse

This presentation will illustrate the innovative and diverse methods that have been used by two metropolitan and two regional palliative care consortia to implement a palliative approach to care into residential aged care facilities (RACFs).

We have a lot to share with you , and just a little time, so the plan is to :• Identify the role of the palliative aged care

resource nurse• Briefly discuss the PA toolkit.• Very briefly describe the approach of 2 regional

and 2 metro consortia. Barriers and enablers.• Where to from here?

Palliative Aged Care Resource Nurse (PACRN)

In 2011-12, as a part of the Victorian Department of Health- Strengthening Palliative Care initiative, funding was provided for four years to facilitate a palliative approach in residential care. In Gippsland, this role was given the title, Palliative Aged Care Resource Nurse (PACRN)… in other regions Palliative Care Support Nurse etc

The broad aims of the PACRN in Gippsland is:

• to build capacity in residential aged care to improve palliative care services to residents

• enhancing linkages between RACFs and palliative care services.

• to support RACFS to adopt a palliative approach and improve end of life care for residents.

Gippsland My role as PACRN commenced role in October 2012. • The Gippsland region covers a land area of 41,524 square

kms stretching from the Bunyip River to the New South Wales border. The total population of the region is 238,907 persons

• Huge learning curve- huge area- 51…now 52 facilities • My background is an advantage• Lots of research, and lots of assistance from PACRN

already established ( Robyn Allen in SMR and Myra McCrae in Barwon).

• Palliative Approach toolkit – used bits• Most importantly… make a plan ( and then change it!)

Location of palliative care services

• Gippsland region:• Snapshot of where the services are• Where are the inpt. beds and the number

Prior research through a federally funded project in Queensland (Prof Deb Parker) had produced the Palliative Approach toolkit in 2010, which had been specifically written for palliative care in aged care. This toolkit is freely available, but is not mandatory for use in building capacity to deliver a palliative approach. Since the release of the toolkit in 2010, it has gone through a review, and additions have been made, and it is now more holistic in its approach. The federal govt is funding a national rollout (limited)

Gippsland • Pilot program in March 2013, and then rollout to the

remainder of Gippsland across the year.• Have trained 125 nurses and allied health

professionals ( and a further 24 in 2014)• Excellent feedback….• A clinical focus was important to engage nurses as

well as attention to the key processes of PA…. We found that you had to “feed’ them the clinical, and then hide in the processes ( sort of like hiding the vegetables!) over the 2 days. We also added a session on change management, and role play for communication skills.

PA toolkit- Gippsland style

Gippsland The challenge….How can we make this training about changing organisational and care practice, and not just about increasing the skills, knowledge and confidence of individual nurses?• Some strategies have been to provide resources (PA

toolkit), provide ppts, and to teach link nurses to teach….(2014 focus)

• Sustainable change has to be supported at all levels, so providing opportunity for engagement with management, clinical staff and carers has been our approach to provide consistency and a person centred focus.

Different Regions… different issues… (political correctness would call them

challenges!)

So… Metro- NWR and EMR Regional – Loddon Mallee

North and West Metropolitan Region Palliative Care Consortium

Implementing a palliative approach2013 Pilot Project

NWMRPCC – Aged Care Project (Jane)• Comprising 14 municipalities in the

north & west region of Melbourne covering 2,981 square kilometres

• Contains four of the six designated growth areas in Melbourne

• Expected population increase of 20% by 2020

• Includes Werribee, Melton, Sunbury, Craigieburn, Whittlesea and everything in to inner city Melbourne

• Approximately 180 aged care facilities within the region

• Includes 3 community palliative care services, Melbourne, Western, Northern and Austin/ Mercy Health

• Diverse social, cultural and economic region

Palliative Approach in RACFs

• Conducted a pilot project in 2013 which included the following– Assessed current usage of support services (including residential

in-reach and community palliative care services)– Deceased resident file audit– Provision of palliative approach education– Support the implementation of end of life care pathways (EOLCPs)– Repeated resident file audit

• Purpose of the pilot project was to scope current practices in the region

• Barriers and enablers to successful implementation of a palliative approach were identified

Current and Future ActivitiesWhere to now!• Completion of PEPA workshops in the region• Toolkit rollout to occur between August to November 2014• Onsite support to be provided to aged care facilities wanting

to implement a palliative approach – could be through attendance at meetings, committees, education or management support

• Development of an aged care support network in the region 2014-15

• Education calendar for the region in 2015 to include– Symptom management for RNs/ ENs– Having difficult conversations/ Case conferencing/ ACPs– Palliative care as a Continuous Improvement activity

Contact Details

• NWMRPCC – Aged/ Palliative Care Project overview

• Project OfficerJane Newbound 0433 418 010jnewbound@mcm.org.au

A LODDON MALLEE REGION APPROACH TO AGED CARE PROJECT

Loddon Mallee Regional Palliative Care Consultancy Service

Kate Cozens – Clinical Nurse Consultant Southern LMRTBA – Clinical Nurse Consultant Northern LMR

Back Ground• Aged Care and Disability

funding is allocated to Bendigo Health and Sunraysia Community Health Services

• Project position located with the Loddon Mallee Regional Palliative Care Consultancy Service

• August 2012 Clinical Nurse Consultants employed for LMRPCCS

Loddon Mallee Region makes up 26% of Victoria’s geography

Project Approach • Link Nurse Model – based on BSW & SMR models• Focused on nursing education

• Utilisation of the ‘Palliative Approach Toolkit’• Education promoted – 3 locations for initial rollout

• Bendigo, Swan Hill, Mildura

• Establishment of Monthly Telehealth education in region (33/61 RACFs have VC capacity) • Sessions are recorded and will be available on consortia

website for all RAC staff• Engagement of stakeholders – meetings with

DONs/care managers/clinical staff

Key achievements 1. 55/61 Residential Aged Care Facilities engaged

and have the Palliative Approach Toolkit• repeat Rollout planned for September 2014

2. 127 RACF palliative care Link Nurses (PCLN) established across the region

3. 12 Full day workshops (approx 480 participants)

4. 80+ inservice sessions

Education Outcomes• Anecdotal evidence

• ‘we have improved care for our residents’• ‘I feel so much more confident to deal with death

and dying’• ‘Caresearch is a brilliant resource’

• What 3 things have you learnt today?• ‘About Nutrition and Hydration at EOL’• ‘Importance of communication at EOL’• ‘Advance Care Planning and EoL Care are related,

but separate processes’

Resident & Family Outcomes• Resident and family outcomes

• “It has been very helpful in particular allowing family to quickly come to terms with J’s pending death and they have been able to spend quality time together in his final days”

• “It's has been a pleasure to work through this process even though the end result for R is not a pleasant thought, at least he will have all the support services in place that will be needed to make his illness more bearable and comfortable”

• Palliative Care Case conferencing in RACFs• “The conferences that I have had with family’s are going

well”

Service provision outcomes

• Increased referrals to Specialist Palliative Care• “Good to know there are extra supports available”• “ I learned more about referring to Community

Palliative Care and Residential In Reach”

EMRPCCEastern Metropolitan Region Palliative Care Consortium

comprises the 7 municipalities of:•Boroondara •Knox•Manningham•Maroondah

Stretching from St Vincent's hospital Melbourne eastwards to Healesville & Warburton East.We contain approximately 130 Aged Care Facilities in the region. Palliative Support Nurses :Lee-Anne Henley & Noreen Treyvaud

Our Approach has consisted of• Personal 1-2hr visit to Facility manager/DON/Clinical Care

Coordinator, giving resources & information sites.• Encouragement & assistance to commence a Palliative

Approach Working group within the facility• Education to staff on the Palliative Approach• Planning strategies with management including corporate

managers on areas they wish to improve • Over 80 facilities now have hard copies of the Palliative

Approach toolkit and training in its use.• Education opportunities to staff on End of Life Care,

Dementia and Palliative Approach, Advanced Care Planning, Communication with Families, Symptom Management,

Assisting Aged Care Facilities to improve their Palliative Approach has involved

• Advance Care Planning support• Links & encouragement to use Specialist Palliative

Care Services & Hospital Inreach• Communication techniques• Family Case Conferences• Care trajectories• Recognition of deterioration & end of life clinical

signs• End Of Life Care Pathways• Self Care for staff to prevent burnout

A Few Findings• Management has to be involved to sustain change• Whole of facility needs an understanding of a Palliative

Approach• Staff change frequently so policies & procedures are

needed for consistency.• There is a plethora of resources available that facilities

do not know about.• Nursing & Care staff’s desire for palliative education

and communication skills is widespread

Ag Aged Care Network

• In 2013In 2013, with discussion on the phone between several of the consortia aged care nurses, a decision was made to hold a teleconference, to enable us to all talk at once, which of course we did!!!!!

• We met face to face at DoH in early 2013, and have done so every 3 months since.

Ag Aged Care Network

• InIn late 2013, after watching the NP mentor at GRPCC set up a portal on caresearch for the NPC, our group decided we could use the same forum to share resources. It is a work in progress, but has provided us with a platform to share resources, and we have even set one up for the disability resource nurses as well. My thanks to the wonderful Ruth Morton at Caresearch who manages the mess I make of it!....

From here…….

• Sustainable change needs a driver…. It is our hope that the role of the PACRN will be continued in the next strategic direction.

• RACF are the last place where many people will live and will die, and a palliative approach aims to ensure care is person-centred and responsive to THEIR needs.

Questions……. And thank you for listening!