Ageless Voice interviews Dr Carol Long who is a principal at Capstone Healthcare and co-director, Palliative Care for Advanced Dementia, Beatitudes Campus on her thoughts on end-of-life care or palliative care. She is also an adjunct faculty, Arizona State University College of Nursing and Healthcare Innovation, Phoenix, Arizona, US:
With the growing population ageing and the importance here for end-of-life care or palliative care at home/nursing home, can you share some innovative approaches that you have seen that help support dying elderly as well as their families?
The demographics of ageing worldwide dictates that healthcare professionals pay more attention to the care of older adults who live their final days in nursing homes or other residential settings. By the year 2030 in the US, as baby boomers reach the age of 65, there will be 70 million older adults and by 2050, 20 percent of the total US population will be age 65 and older. In addition, 70 percent of deaths in America are in those age 65 years of age and older. For many, their healthcare needs are complex; with many suffering multiple-disabling medical conditions in their final years. Of interest is data that 33 percent of residents in nursing homes are most likely to die there and as one ages, there is an increased likelihood that nursing homes will become their final, permanent residence (National Center for Health Statistics, 2011). Many die in hospitals or nursing homes where palliative care may not be available. Nursing home staff require training in end-of-life care principles.
The End-of-Life Nursing Education Consortium (ELNEC) has been on the forefront of change with training in palliative care principles across all healthcare settings. Specifically, the ELNEC-Geriatric Train-the-Trainer provides education and training for nursing staff who work in nursing home settings. Focused education includes assessing and addressing pain and non-pain symptoms; identifying goals of care; incorporating ethical principles; culture and spiritual considerations in the care plan; developing communication skills; understanding loss, grief and bereavement; and preparation and care at the time of death. Nurses who complete ELNEC can provide training in their own employment settings and create change by improving care practices in their facility. (ELNEC-Geriatric Training and ELNEC-Geriatric Train-the-Trainer was provided at Hua Mei Training Academy.) For example, at Beatitudes Campus, a “Campaign against Pain” was initiated to help nurses provide pain relief for people residing in the Health Care Center, which is a skilled nursing facility.
A second effort is the Palliative Care for Advanced Dementia programme at Beatitudes Campus which makes comfort-care the No 1 goal in all care that is provided for persons with dementia. Since dementia is a terminal illness, caregiving staff direct all of their attention to comfort practices, ranging from full liberalisation of diets to aggressive pain management to integrative approaches that include pet therapy, massages and intergenerational activities with children. There are no physical restraints and caregiving staff abandon the usual nursing home task schedule to one that is based on a person’s own individual needs. For example, there are no shower schedules and dining is ‘on demand’.
Thus, nursing homes must be innovators in supporting the older adult and their families who are approaching the final years and days of their lives to assure a ‘good death’. Finally, nursing homes need to be person-directed and comfort-focused in all aspects of care.