Reform Directive on Caring for People at the End of Life - Essay Example

Reform Directive on Caring for People at the End of Life The National Health and Hospital Reform Commission’s (NHHRC) reform directive on caring for people at the end of life has been addressed from a health services manager’s perspective. Issues related to operation, implementation, efficiency, effectiveness, equity, outcomes and quality of implementation have been addressed. Also, effects on other aspects of the health care system have been addressed. High quality palliative care could be provided by focusing on the individual, and forming partnerships between the individual, service provider, family and carers. The treatment should focus on relieving the symptoms experienced by the individual, and providing emotional and practical support to the family and carers (Abbey, 2006). Workforce, training and integration of services have been major barriers in the provision of quality end of life care. This has been recognized and general practice and specialist palliative care linkages with residential aged care facilities are being developed (Palliative Care Australia, 2008). The quality of life for individuals with life-limiting illness and their families could be improved by a palliative approach. The aim of palliative approach is to reduce suffering by early identification, assessment and treatment of individuals, with needs in areas such as pain, physical, cultural, psychological, social, and spiritual. The approach could be beneficial in reduction of individuals and families potential distress, by the provision of sufficient information to facilitate the decision making process. The approach is most effective when provided by a multidisciplinary team, and could be provided in a surrounding that the individual is familiar and comfortable in. Advance care planning requires systematic implementation, including communication between individuals, family and care givers. Educational programs for care team and individuals on a regular basis increase the probability of plans being completed and implemented. Comprehensive advance care plans should include regular assessments and responding to changes in resident’s health (The National Palliative Care Program, 2006). Our vision for the provision of quality care at the end of life is to satisfy the needs of individuals, and commitment to necessary action for achievement of quality care. We plan a service delivery based on needs, supporting the individual’s appropriate choice of place for delivery of service, development of workforce including education and training, greater service integration for continuity of care, provision of sustainable workforce, co-ordinating advance care planning, and facilitating continual improvement of quality in end of life care standards (Palliative Care Australia, 2008). Quality end of life care could be a reality for all Australians on improvement of the health care system, and providing access to end of life care. The role of NHHRC in developing an effective and efficient health care system that is focused to the needs of the people has been appreciated. This is an opportunity for health care services to greater access end of life care for promoting the quality of life for people, and providing them with greater range of choices. Planning for the management of terminal phase of life would provide better care to patients by the efficient use of services and prevention of unnecessary hospitalisations. Challenges to the strategy are the integration of palliative care across the health system, defining the affected population and characterizing their needs, and meeting the needs of consumers, their preferences and expectations. Patients have to transact with several systems, with few links and enablers creates the opportunity for a wide range of collaborating opportunities for several stakeholders (Palliative Care Australia, 2008). ANZSPM has emphasized that funding models, policies, governance and key performance indicators developed by the State government for Specialist Palliative Care (SPC) services has not provided recognition to the role of SPC services in primary care services. Despite being underfunded, many SPC services try hard to support primary palliative care providers. SPC services need to be closely involved for maintaining quality, standards and continuity of care. Timely referral to community palliative care services are facilitated by hospital teams, and multidisciplinary end of life care in acute care settings are promoted by linkages with other specialists (Australian and New Zealand Society of Palliative Medicine, 2009). Specialists in Palliative Medicine are integral to provision of SPC service. Palliative Care Australia has recommended 1.5 fulltime equivalents (FTE) Palliative Medicine Specialists per 100,000 population. The Royal College of Physicians, UK has recommended at least 2 FTE Palliative Medicine Specialists per 250,000 population. ANZSPM has recommended at least 2 FTE Palliative Medicine Specialists per 250,000 population. A substantial change in the pattern, such as increase in patients with organ failure, degenerative neurological disease, dementia, etc., many more Palliative Medicine Specialists would be required. A shortfall in Palliative Medicine Specialists in Australia has been illustrated in Table 1. Approximately only half the number of Palliative Medicine Specialists are available to serve the population (Australian and New Zealand Society of Palliative Medicine, 2009). Table 1. Palliative Medicine Specialists in Australia (Australian and New Zealand Society of Palliative Medicine, 2009). Community and SPC services should be through Palliative Medicine Specialists, and Palliative Medicine Specialists should be involved in community work through community visits or outpatient clinics. Hospital services are overused as a consequence of under resourcing of Palliative Medicine Specialists in community services. Coordination and integration of care should be promoted by the integration of hospital and community of palliative care services. A large number of patients have been dying in residential aged care facilities, and such facilities should have greater access to SPC services. It is important that quality is maintained across settings and services. A system is required to maintain standards for end of life care in primary and specialist services, and promote continuity of care. There are four processes for the development of standards for end of life care by SPC services. They are: National Standards Assessment Program, the Palliative Care Outcomes Collaboration, Palliative Care Knowledge Network, and ANZSPM’s Clinical Indicators Working group. Community based Palliative Care Service would need to be enhanced and well coordinated for effective services for patients and carers. These include services that operate all hours and have incorporated continuous quality improvement processes (Australian and New Zealand Society of Palliative Medicine, 2009). Inequities in palliative care services will need to be addressed. Adequate remuneration should be available to make palliative care more available in the community. Consultant physician, with the exception in psychiatry, in surgery or hospital could be referred, or review referred patient treatment and management plan. Palliative Medicine Specialists holding a FRACP and seeing patients in surgery or hospital are eligible. Palliative Medicine Specialists holding a FAChPM are ineligible. In a society which believes that seeing patients in homes or nursing homes in the community is helpful for patients and beneficial, appropriate rewards and incentives must be available for this practice. There is a need for coverage of home based palliative care by private health insurance. There are several benefits, including increasing choices for consumers, meeting the increase in demand for home based services, reducing pressure on public resources, and increased opportunities of private practice to Palliative Medicine Specialists, thus providing an incentive to doctors to practice this speciality. Other barriers for provision of Interdisciplinary Team (IDT) Specialist Palliative Care in Private Hospitals exist, such as Palliative Medicine Specialists not receiving adequate remuneration for seeing patients and/or their families for discussions of end of life care, management, IDT meetings with family or meetings for planning of coordinated care (Australian and New Zealand Society of Palliative Medicine, 2009). There is a need for widespread introduction of advance care planning. Advance care planning costs should include longer term cost savings of the process and associated costs to discourage putting unfunded load on services that have been already stretched. Advance care planning training is required for junior doctors. State training bodies need to plan and address advance care planning, especially those states where populations have advanced chronic disease or frailty or dementia. Recognition at executive health service level and funding for specialist Palliative Care Services will be required to make such education a standard part of core business (Australian and New Zealand Society of Palliative Medicine, 2009). An important step in addressing the end of life care needs is the identification of end of life population. Uncertainty of the time of death adds to the challenge of defining the end of life population. This adds to the complex task of planning and delivering care systems. Among 130,000 people that die each year, Palliative Care Australia has estimated that at least 100,000 deaths could be categorized as expected, and could be classified as those requiring planning and coordination for quality of end of life care. For the provision of services that are equitable, of good quality and sustainable, a mechanism to collect and analyse data on how the population transacts and utilizes health and care systems, and whether their needs are met. Inequality and inconsistency seem to be the state of end of life care, where patients experience care that is fragmented, fails to address their care preferences, and does not deliver adequate support for meeting social, emotional and physical needs at the end of life. Experience in end of life care is disparate and inconsistent, where access to services, models of care, and care standards are inconsistent. In acute care settings, specialist palliative care units and hospital based consultation are inaccessible to patients. Often, adequate care may not be provided and unreliable transitions between services forced on the patients. This could be aggravated by excess demand and or shortages in workforce. Similar inconsistencies and inequities prevail in complex and chronic settings. Disparity in access to services and differences in capacity of services are inequities and inconsistencies for care in the community. Access to and qualities of end of life care are inconsistencies in aged care. Systemic barriers caused by the location of care inhibit meaningful choice for patients. Lack of quality care at home or in residential aged care result in frequent emergency visits and hospital stays, resulting in detrimental health consequences and increase risk of infection and falls. Such events are avoidable by advanced care planning involving the patient, care providers, family, carers and loved ones. Such planning allows for articulation of patient’s care preferences, and enhances their choices and control of their end of life care. Integration of advance care planning in health systems is underway, and will incorporate legal matters and State/Territory directives, and promotion of the concept among consumers and health professionals (Palliative Care Australia, 2008). The need for integration of primary and aged care and specialist palliative care services has been recognized and received widespread support. This should be backed by supportive resources for practitioners, and service providers enabling them provide quality end of life care. Also, the recognition of the linkage between palliative care and advance care planning has been viewed as an excellent step forward (Palliative Care Australia, 2009). Standard of care to be expected has been defined in Standards for Providing Quality Palliative Care for all Australia. The National Standards Assessment Program has been established to develop service level quality improvement program and self assessment for specialist palliative care service providers. Guidelines for palliative approach in residential aged care facilities have been endorsed by National Health and Medical Research Council. The document includes intent and processes for the assurance of quality care at the end of life, and has been introduced to residential care facilities. A data collection program has been developed to track and compare clinical activity among patients. This Palliative Care Outcomes Collaboration program is comprehensive and will serve to benchmark services, and combined with the National Standards Assessment Program will provide the basis for the measurement of performance in quality care (Palliative Care Australia, 2008). References Abbey, Jenny. (2006). Palliative Care and Dementia. [Brochure]. Queensland: Alzheimer’s Australia. Australian and New Zealand Society of Palliative Medicine. (2009). Submission to the National Health and Hospitals Reform Commission’s interim report A Healthier Future for All Australians. [Brochure]. Braidwood, NSW: Australian and New Zealand Society of Palliative Medicine. Palliative Care Australia. (2008). ‘End of life care is everyone’s affair -tackling the challenge of ‘end of life.’ [Brochure]. Deakin, ACT: Palliative Care Australia. Palliative Care Australia. (2009). ‘Palliative Care Australia (PCA) response to NHHRC interim report.’ Deakin, ACT: Palliative Care Australia. The National Palliative Care Program. (2006). Guidelines for a Palliative Approach in Residential Aged Care (Enhanced Version ed.) [Brochure]. Deakin West, ACT: Edith Cowan University. Read More