Ontario developed the “Fixing Long-Term Care Act” in response to the crisis in long-term care (LTC) that occurred during COVID. They promise to enforce adherence. However, the crisis in LTC in Ontario is not unique – LTC facilities across the country are struggling (Ontario, 2021).
A palliative approach in LTC is cited as a key component of the Fixing LTC Act. It is also the only way that appropriate care can be provided for the increasing numbers of aging Canadians over the next decades.
A palliative approach to care is defined in the Life and Death Matters resources as
Care that “is provided by physicians, nurses and other healthcare providers who work together to provide the best quality of life possible when patients are facing any life-limiting illness. It is appropriate at any age, at any stage, and it can be provided along with curative or disease modifying treatment.”
(Murray, 2020)
Richard Sawatzky and his group identified how to put this definition into practice with three “overarching themes,” 1) Begin integration early in the disease process, as soon as diagnosis, 2) Adapt palliative care knowledge to be provided throughout the course of illness, and 3) Build a palliative approach into all health care systems and models (this would include a palliative approach in LTC) (Sawatzky et al., 2016).
A question being asked across the country is, “How can LTC facilities meet all of these challenges of integrating a palliative approach?”, acknowledging that integrating a palliative approach will revolutionize the way that care is provided in LTC. All members of the health care team, including HCAs, HCWs, and PSWs, will need new skills for providing palliative care early in the illness and throughout the course of the person’s illness.
In this article, we describe three seamless ways for LTC facilities to support caregivers to develop the skills and knowledge they need to integrate a palliative approach to care for individuals living in LTC. Not surprisingly, they all involve education!
“How can LTC facilities meet these challenges of integrating a palliative approach?”
Enrol staff in self-paced online education to support PSWs to integrate a palliative approach
LTC facilities can support HCAs, HCWs, and PSWs to develop palliative care skills and knowledge by providing enrolment in programs like PACE for PSWs. This is a self-paced online program of palliative care education, written specifically for PSWs, HCWs, and HCAs. The ten competency-based courses are engaging, affordable, and user-friendly. Program graduates receive a National Certificate in Palliative Care that identifies their competency in providing palliative care and integrating a palliative approach.
Graduates of the PACE for PSWs program report increased confidence and competence in providing palliative care. After completing these courses, graduates indicated they had developed a thorough understanding of their role in integrating a palliative approach and had learned essential practical skills for providing care for a person from diagnosis throughout their and through death.
Introduce a palliative approach with multi-stream education for healthcare teams
In a very recent study, an organization began integrating a palliative approach into their LTC facilities by offering all team members access to multi-stream education – online courses, face-to-face training, and coaching. The education addressed the negative perception that many people in LTC held about the terms “palliative” and “palliative care”, the need for early goal-of-care conversations, and the lack of benefit with hospital transfers at end-of-life.
After completing the education, more LTC residents participated in goals-of-care conversations than previously. And there was a substantial decrease in transfers of LTC residents to hospitals at end-of-life. The researchers reported that “teams were having earlier GOC [goals-of-care] conversations with residents. Teams also reported improvements in the quality of care provided to residents and their families”(Sarakbi et al., 2022). This multi-stream approach demonstrates that education that addresses one or two aspects of a palliative approach at a time can be successful in improving the care for the person.
Provide in-house “bite-sized bits” to care teams on ways to integrate a palliative approach
An LTC facility shared with us their plans for supporting staff to integrate a palliative approach into care. The organization designed and developed an education program for its staff and had a specialist educator delivering the content in 15-minute “bite-sized pieces.” All team members are taught on the same day; however, they attend a session on the floor or location where they provide care.
Their education was not multi-stream nor self-paced, however, it was equally effective. Consider this example. One “bite-sized bit” they taught was “The Surprise Question.” Teaching about the surprise question meant that team members were aware: 1) That all people in their care were living with life-limiting illnesses and were dying. 2) Of the need to identify subtle signs of decline in a person’s health.
Because HCAs/HCWs/PSWs spend the most time with LTC residents, the surprise question was an excellent tool for them. They would be most likely to notice the subtle changes in a person’s health as days, weeks and months pass. It is the subtle changes in health that might be missed by other less involved caregivers. The personal knowledge/experience of the HCAs combined with their understanding of the surprise question and support from other members of the team, provides valuable insight into subtle changes in the health status of a person. With this information, the team is better able to support the person and family with a palliative approach throughout the person’s decline.
Tell us your thoughts about integrating a palliative approach in LTC
Tell us about your experiences with integrating a palliative approach. Has your team tried any of these strategies? Or do you have other strategies to share with us?
Share your thoughts in the comments below.
Bibliography
Murray, K. (2020). Integrating a palliative approach: Essentials for Personal Support Workers (A.-M. Gilbert, Ed.; Second).
Ontario. (2021). Fixing Long-Term Care Act, 2021. https://www.ontario.ca/laws/statute/21f39
Sarakbi, D., Graves, E., King, G., Webley, J., Crick, S., & Quinn, C. (2022). Gift of time: learning together to embed a palliative approach to care in long-term care. BMJ Open Quality, 11(3). https://doi.org/10.1136/bmjoq-2021-001581
Sawatzky, R., Porterfield, P., Lee, J., Dixon, D., Lounsbury, K., Pesut, B., Roberts, D., Tayler, C., Voth, J., & Stajduhar, K. (2016). Conceptual foundations of a palliative approach: A knowledge synthesis. BMC Palliative Care, 15(1). https://doi.org/10.1186/s12904-016-0076-9
