Increasing pressure on both public hospitals and hospices is resulting in more patients being “admitted-to-die” into aged residential care facilities (rest homes), which are not typically set up to provide specialist palliative care services.
As a result of their recent investigation into the practice, researchers from the University of Otago, Wellington, are calling for changes to the way palliative care is provided to patients including a new, appropriately funded model of palliative care in these situations.
Associate Professor Eileen McKinlay explains that as hospitals and hospices are under increasing pressure to free up inpatient beds for acute or urgent care and to manage demand, they are discharging patients into rest homes who are expected to die within three months, including some aged under 65.
The recent investigation was the first New Zealand study to report on the care of cases admitted-to-die within three months of entering a rest home. Researchers found those admitted had high and complex palliative care needs caused by the fact they often had a number of different health problems (multimorbidity), often including advanced cancer.
“Our case study in one aged residential care facility showed these patients who die within three months of admission have high symptom needs and require clinical support from health and social care professionals, not only from the facility, but from District Health Boards, hospices and other privately-contracted professionals,” Associate Professor McKinlay says.
“Although the professionals involved are well trained, willing and committed, they do not have a structure to coordinate care between the organisations. Also, aged residential care facilities are significantly underfunded to provide the care for patients and whānau with complex and urgent palliative care needs and building environments are not suitable for those aged under 65.”
There is no specific DHB funding for patients with complex palliative care needs who are admitted-to-die in rest homes, which means these facilities cannot employ sufficient staff with an ideal skill mix to look after these patients, the study found. There is also no specific funding to support collaborative, inter-professional specialist palliative care, no common electronic platform for health professionals to communicate collaboratively and no DHB-wide pool of specialist resources like syringe drivers or specialist beds and chairs.
Associate Professor McKinlay says that as the increasing and ageing New Zealand population reaches end-of-life, hospitals and hospices will not be able to provide ongoing specialist palliative care and admission-to-die in specific rest homes may be a viable alternative.
“However, aged residential care facilities are not currently set up or staffed to provide specialist palliative care of those admitted-to-die and a specific model of care, which is funded appropriately by the government is required.”
The research paper ‘What does palliative care look like in a New Zealand aged residential care facility when patients are admitted to die?’ was published in the most recent issue of the New Zealand Medical Journal.