A Palliative Approach in Residential Care Settings (March 2014)

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


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


What is Palliative 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)


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.




Considering Settings:Specialized Palliative Care vs. A Palliative Approach



Frail EldersWho do you see on your units?Who is living in residential care?


Eden Alternative: 10 Principles of Care

Taken from http://edenalt.co.za/wp-content/uploads/2013/01/Eden-SA-Poster2.png


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)

Providence Health Care

The

Ambiguous Dying Syndrome

The ambiguous dying syndrome. Bern-Klug M. Health Soc Work. 2004 Feb;29 (1):55-65.


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



Visualizing Palliative Care in Treatment Across Time:In Residential Care Settings


A Palliative = Goals of CareApproach to Care Conversations


A Palliative Approach to Care =

Providence Health Care

A Palliative = Goals of CareApproach to Care Conversations

• Formal / Informal• Documented• Timely• Continuous + progressive across residential + acute care settings


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





Thank You!Holy Family Hospital Extended Care Unit

Staff + Family

PHC Palliative Care ProgramPHC POCT Residential Care Team

Tilly Schalkwyk RN, MSN, CNSElder Care Program, PHC Residential Care

iPanel + InspireNetAlliance for Quality Palliative Care in Long-Term Care

The Way ForwardNational Framework Initiative for Hospice Palliative Care Integration

Health & Medicine

A Palliative Approach in Residential Care Settings (March 2014)