Here’s an update from Dr Rosemary Frey on SHARE – a new collaborative model to enhance the delivery of palliative care through increased integration between aged residential care providers and hospice.
First the bad news –
In New Zealand, 38% of people die in Aged Residential Care (ARC), one of the highest rates in the world (Broad et al, 2013). Over 37% of residents discharged from an acute hospitalisation had died within the first six months after ARC admission, leading to claims they are acting as ‘de facto’ hospices (Connolly et al, 2014).
However, ARC staff often are unprepared for their role in palliative care provision. For example, they feel ill-equipped to undertake Advance Care Planning (ACP) conversations. Supporting ARC nursing staff (Registered Nurse and Health Care Assistants) in developing their skills and knowledge to care for residents with a life-limiting illness is therefore a priority, both in New Zealand and internationally.
Michal Boyd and colleagues in 2011 also noted a current lack of gerontology expertise for palliative care specialists from hospice who may have limited experience with the complexities of care for those with frailty and dementia (over 65% of aged care residents have some form of cognitive impairment). There are currently examples of palliative care integration into aged care facilities from many hospices, yet there are few consistent models of care throughout the country. This has led to a rather ‘ad hoc’ approach to the integration of specialist palliative care in ARC facilities.
Now the good news –
We’re developing a new collaborative model to enhance the delivery of palliative care through increased integration between aged residential care providers and hospice. It’s called SHARE: (the Supportive Hospice and Aged Residential Exchange) programme and you can read all about it in Nurse Education in Practice. In the article, we present results of our pilot for a new model of palliative care designed to integrate specialist palliative and ARC services. The new model includes focused palliative care needs assessment clinical coaching and role modelling, which will help ARC and hospice staff put new learning into practice. The goal of SHARE is to help clinical staff improve palliative care within residential aged care facilities and to improve specialist palliative care nurses knowledge and skill to care for frail older people. SHARE builds on the strengths of current palliative care practice by combining new learning in ARC with what staff members do now.
Results from the SHARE pilot undertaken in two ARC facilities indicate that the intervention is perceived by participants as being useful especially in relation to keeping notes well-documented and alerting Registered Nurses and Health Care Assistants to weight gain and loss. Relationships between hospice and facility staff, and consequently facility staff and patients and their families, are seen as the key to the success of the project. Facility staff members were keen to learn, and the Hospice nurses reported a new respect and knowledge regarding the care that is undertaken in residential aged care.
A larger evaluation of SHARE funded by the School of Medicine Foundation/ Freemason’s Foundation is underway. The new study, undertaken in collaboration with Mercy Hospice and North Shore Hospice, who will be funding SHARE implementation, will take place over 12 months. Twenty ARC facilities will be involved in the trial.
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