A basic presentation presentation on the topic of applying a palliative approach to residential care settings for elders + their families. It covers a review of palliative care + terminology then distinguishing between specialized palliative care + an a palliative approach. Emphasis is placed upon goals of care conversations as the primary means to integrate a palliative approach to care for elders.
A Palliative Approach in Residential Care Settings (March 2014)
1. Providence Health CareProvidence Health Care
A Palliative Approach
in Residential Care Settings
Joan Pham RN, BScN, CHPCN (c)
Palliative Outreach & Consult Team - Residential Care
March 2014
Bear by Coast Salish artist Andy Peterson, Skokomish Nation
2. Providence Health CareProvidence Health Care
Overview
• What is Palliative Care
– Visual: Palliative Care + Treatment Across Time
– Terminology:
• Palliative Care vs. End of Life Care vs. Terminal Care
• Specialized Palliative Care vs. A Palliative Approach to
Care
– Settings
– Disease Trajectory
• Frail Elders
– Eden Principles + Palliative Approach
– Who is living in Residential Care?
– Ambiguous Dying
– Visual: Palliative Approach + Treatment Across Time in Residential
Care Settings
• Goals of Care Conversations
• Resource: iPal app
4. Providence Health CareProvidence Health Care
What is Palliative Care?
• An approach that improves the quality of life
• For patients and their families
• Facing the problem associated with life-
threatening illness
• Works to identify + relieve suffering:
Pain and symptom management
• Psycho social and spiritual care
• Medical treatment and disease management
• Preparing and managing for dying
• Bereavement
(World Health Organization)
5. Providence Health CareProvidence Health Care
Visualizing Palliative Care in Treatment Across Time
• Murray S, Kendall M, Boyd K and Sheikh A. Illness trajectories and palliative care. BMJ 2005 4; 330;
1007-1011 doi:10.1136/bmj.330.7498.1007 (adapted from Lynn and Adamson 2003).
• Adapted from Lynn and Adamson, 2003. 5 With permission from RAND Corporation, Santa Monica,
California, USA.
11. Providence Health CareProvidence Health Care
Eden Alternative: 10 Principles of Care
Taken from http://edenalt.co.za/wp-content/uploads/2013/01/Eden-SA-Poster2.png
12. Providence Health CareProvidence Health Care
Who is living in residential care:
• 48% of all residential clients who were admitted
and died during (FY 09/10 – 10/11) died within
90 days of admission
• At BFH and HFH, 65% and 62% of residential
clients died within 90 days of admission
(Decision Support, Providence Health – July 2011 Report)
14. Providence Health CareProvidence Health Care
We are living longer. By 2025:
• 30% of the population > 65.
• 33% increase in deaths over 2004.
• 2/3 will die with 2 or more chronic diseases after months or years in
state of “vulnerable frailty”.
• Only 20% of us will die with a recognizable terminal (“palliative”)
phase.
The Senate of Canada. (2010). Raising the Bar: A Roadmap for the Future of Palliative Care in Canada.
Available at: http://secure.cihi.ca/cihiweb/products/end_of_life_report_aug07_e.pdf
19. Providence Health Care
A Palliative = Goals of Care
Approach to Care Conversations
• Formal / Informal
• Documented
• Timely
• Continuous + progressive across residential + acute care settings
20. Providence Health CareProvidence Health Care
Goals of Care Conversation Tips
• Record conversations
– Formal / Informal
– Details
• Expect to repeat yourself
• Meet residents + families where they are at
• Strengthen impact of conversations
– Provide educational materials
– Follow-up conversations
– Build on relationships
• Continuity
– Acute + Residential Care settings
– Record of conversations
24. Providence Health CareProvidence Health Care
Thank You!
Holy Family Hospital Extended Care Unit
Staff + Family
PHC Palliative Care Program
PHC POCT Residential Care Team
Tilly Schalkwyk RN, MSN, CNS
Elder Care Program, PHC Residential Care
iPanel + InspireNet
Alliance for Quality Palliative Care in Long-Term Care
The Way Forward
National Framework Initiative for Hospice Palliative Care Integration
Notas del editor
At Providence Health Care we have tried to make both approaches available in the past 7 years via POCT teams
Acute vs. Residential Care
Evolving the model for residential care: INTEGRATION + EMBEDDING
Social work literature to name this ambiguous last months to year of life – frailty + implications on family / needs
What do YOU understand / What do YOU expect to happen next?
As opposed to “what do you want us to do at this time?”
Take the burden OFF families weighted with decisionmaking
Expect to repeat yourself. The receiving mind may not hear reality at first..it may be an emergin understanding…a realization that comes form repeating or hearing it from different people in different ways. So repeating yourself may also mean the words you used may need to shift a bit to become more hearable.