A Palliative Approach in Residential Care Settings (March 2014)
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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.
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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
- 3. Providence Health CareProvidence Health Care What is Palliative Care?
- 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.
- 6. Providence Health CareProvidence Health Care
- 7. Providence Health CareProvidence Health Care
- 8. Providence Health CareProvidence Health Care Considering Settings: Specialized Palliative Care vs. A Palliative Approach
- 9. Providence Health CareProvidence Health Care
- 10. Providence Health CareProvidence Health Care Frail Elders Who do you see on your units? Who is living in residential care?
- 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)
- 13. Providence Health Care The Ambiguous Dying Syndrome The ambiguous dying syndrome. Bern-Klug M. Health Soc Work. 2004 Feb;29 (1):55-65.
- 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
- 15. Providence Health CareProvidence Health Care
- 16. Providence Health CareProvidence Health Care Visualizing Palliative Care in Treatment Across Time: In Residential Care Settings
- 17. Providence Health CareProvidence Health Care A Palliative = Goals of Care Approach to Care Conversations
- 18. Providence Health CareProvidence Health Care A Palliative Approach to Care =
- 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
- 21. Providence Health CareProvidence Health Care
- 22. Providence Health CareProvidence Health Care
- 23. Providence Health CareProvidence Health Care
- 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 do 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.
- Jenica Burns Simin Tabrizi Tilly Schalwyk