Long term Care

Often your initial step in this process is to pull together a group of staff who share a common interest in palliative care and are committed to improving the quality of care offered to the residents and families in your long-term care facility. It is best if this group includes representatives from the various disciplines or departments involved in providing care in your facility. If possible, include an interested family member and a representative from the local palliative care team.

Engaging the support of administration staff is crucial to the success of any palliative care team. Discuss how they would like to be involved: do they want to be part of team, or, if not, how would they like to be kept informed? Ideally, members of your palliative care team will be viewed as leaders by their peers and can act as catalysts for change. They can encourage others to get “on board” with your activities and practice changes.

Once the team is formed, establishing goals and defining a role within your facility are the next steps. For example, will the team be responsible for ensuring necessary policies, procedures, and supplies are in place? Or perhaps the team will develop an education strategy for staff and families. Or will the team be involved in direct care by acting as consultants within the facility to help assess and plan care?

Other components of care often addressed by teams are:

• creating a comfortable environment for residents and their families (who may be spending more time at the facility);
• developing ways to offer information and support to the residents’ families during the final days of care and into bereavement;
• assessing the educational needs of staff and plan an education strategy;
• developing a strategy to acknowledge and support staff who also grieve the death of residents in their care.
  

Teams often start by brainstorming a “wish list” of ways they can improve the palliative care your facility provides. To help prioritize this list, the team should establish realistic objectives, develop a work plan with reasonable time frames, and identify ways to involve other staff and outside resources. Starting with one change and building on that success is a helpful approach.

Throughout the process, it may be very helpful to connect with other long term care facilities that have already begun this type of work and connecting with the local palliative care program staff or the local/provincial hospice office. They are potential sources for information, expertise, guidance, assistance with document development, or assistance with planning and delivering education sessions.

References

Wowchuk SM, McClement S, Bond J Jr. (2006). The challenge of providing palliative care in the nursing home: part 1 external factors. Int J Palliat Nurs, June; 12(6): 260-7.

Wowchuk SM, McClement S, Bond J Jr. (2007). The challenge of providing palliative care in the nursing home part II: internal factors. Int J Palliat Nurs, July;13(7):345-50.

Phillips JL, Davidson PM, Ollerton R, Jackson D, Kristjanson L. (2007). A survey of commitment and compassion among nurses in residential aged care. Int J Palliat Nurs, June;13(6):282-90.