Needs Round model triggers better palliative & residential aged care in Kogarah

Nurse Practitioners Josh Cohen and Carmen Sanchez offer support to residential aged care facilities, collectively representing some 4,000 aged care beds in their area.

Based at Calvary Kogarah in South Eastern Sydney LHD, Josh explained that at commencement in 2017 the service inherited an under-resourced but much demanded liaison role into residential aged care.

“Prior to the Nurse Practitioner positions there was one 0.6 FTE CNS2 who was doing a great job but understandably time-poor.”

Soon after Josh commenced additional funding was secured for a second NP position which Carmen filled.

An earlier (2016) scoping study had surveyed local aged care facilities to identify what support they needed.

“We knew that the facilities wanted better access and more timely access to palliative care in the district, they also wanted education and family education around palliative and end of life issues, they wanted timely access to end of life medications, and they wanted good palliative care support for their GPs”, said Josh.

Since commencing, the focus of their interaction with the residential aged care facility is to conduct a ‘palliative care needs round’, a staff conference to discuss identified or ‘referred’ residents and their particular support needs.

Josh said that he was attracted to the needs round model because it offered an approach by which specialist palliative care could an ongoing feature of residential aged care.

In the period from February to September this year they have overseen 36 palliative care needs rounds initially across 18 participating RACFs. The number of referrals overall was 192, which was up by 25% from the same period last year.

Carmen explained their initial involvement with a residential aged care facility was to run staff training in key indicators for palliative care, referred to as triggers. These triggers include: expected prognosis less than 6 months (representing the reason for 17% of referrals to the needs round), physical and cognitive decline (46%), no advance care plan (20%), family conflict (7%) and last days of life (9%).

Their aims are to remain present in residential aged care, to increase the capacity of facility staff to recognise palliative care need, to increase community participation in advance care planning in residential aged care, to improve understanding about speciality palliative care and to raise awareness about the value of palliative care for family members.

Staff turnover and adjustment to the program represented a challenge as the program developed.

Another of the challenges was the different approach to palliative care needed in residential aged care.

“The longer I do this job the more I realise that specialist palliative care in residential aged care is very different to the palliative care I was used to, so I’m learning to do it all over again”, said Josh.

Josh and Carmen were speaking at the 6th Annual Aged Health Collaborative Forum held at Westmead Hospital on the 26th of October 2018.

Pic: Josh Cohen and Carmen Sanchez at the 6th Annual Aged Health Collaborative Forum