Residential Care & Assisted Living
Coping with the end of life is often a difficult process for people and their families. In response, Fraser Health is collaborating with all long-term care teams in the region to enhance the care experience for people and their families through integrating a palliative approach and serious illness conversations into their usual care processes.
A palliative approach aims to improve the quality of life for people living with life-limiting illnesses, as well as support and prepare families for what may be ahead. This approach understands the progressive nature of chronic life-limiting illnesses and is used to ensure quality of living and dying earlier in the person’s disease trajectory. It incorporates the same principles as palliative care while proactively avoiding crisis and needless suffering in someone’s last months.
To make these changes, Fraser Health’s Residential Care & Assisted Living team began by holding focus groups with key stakeholders and identifying a number of opportunities for improvement through a collaborative model of engagement and education. Some of the key areas of improvement they discovered were related to communication, documentation, and early recognition of frailty and changes in function. For example, conversations with people living in long-term care had been either undocumented or inaccessible because they were in discipline-specific progress notes, which often led to confusion for care teams who were not familiar with the individuals’ wishes or preferences. As well, teams were lacking the competency and confidence to have serious illness conversations with people living in long-term care and their families.
Overall, Fraser Health’s goal is to ensure that care reflects individuals’ and families’ needs and desires. Families play an important role in a palliative approach to care, especially during conversations about preparing for end of life and expressing personal values and preferences regarding care and treatment. A palliative approach to care enables the individual and family voice to be integrated throughout the care journey. A patient advisor was recruited from the Patient Voices Network during the project to support the planning and evaluation of the palliative approach and subsequent guidelines and tools.
Early evaluation results indicate that efforts to integrate the individual and family voice have led to a decrease in inappropriate transfers to acute care and an increase in staff competence and confidence in caring for people through to end of life. Transfers to acute care may cause unnecessary suffering and distress and result in care that doesn’t align with a person’s preferences. Through open communication, early recognition of decline, proactive symptom management, accessible documentation, and the inclusion of the family voice, long-term care teams are better able to integrate individuals’ and families’ values, needs and preferences.