Embedding a Palliative Approach in Residential Care.
As people are living longer with chronic illness, a Palliative Approach to Care is essential to achieve the goal of providing excellent, cost effective care for older adults with complex and advanced illness. Meeting the needs of older people requires improving access to palliative care, to include people dying from diseases other than cancer, and who may have multiple illnesses.
In 2011, Michele Cook, manager of Evergreen House on the North Shore, approached the Palliative Care team at Lions Gate Hospital with a proposal for enhanced collaboration between the two programs. Implementing a Palliative approach in Residential care had been the subject of Michele’s dissertation- “Shifting Daisies”. The Daisy Project was initially launched at Evergreen House in September 2011 but did not have the impact that was expected, and it became obvious that more research and study was required.
In 2012 another residential care centre on the North Shore, took on the challenge of creating a framework for a sustainable, palliative approach to care, that would demonstrate quality improvements to care delivery at end of life. A team of Nurses and a social worker at Kiwanis Care Centre used lean methodology to create “The Daisy Project“: embedding a palliative approach in residential care.
The project team was awarded the 2015 Excellence in Quality Award, coping with end of life, by BCPSQC and also a VCH People First Award for Excellence in Teamwork.
The project team developed education modules for residential care aides (RCAs), and those who have completed the 9 hour, certified course, wear a daisy pin. The education includes advanced skills in communication, non-pharmaceutical symptom management, ethics, self care and holistic care.
Education was also developed for Nurses and the interdisciplinary team to enhance open, honest communication about Goals of Care.
Talking about end of life is not easy for most people. However, talking can help everyone better understand their medical condition and the choices they have to make.
Decisions about healthcare are often based on a persons values or beliefs and it is important that the healthcare team knows what these values and beliefs are so that they can plan and talk about how the resident would like to be cared for at the end of their life.
The Daisy Program (planning for living well) is currently offered at all VCH residential sites, and many contracted sites, within the Coastal. Community of Care.
A unique partnership between residential sites and the North Shore Palliative and Supportive Care Program (NSPSCP) has been developed. For residents residing in facilities on the North Shore, there is access to many resources and the “Every day Counts” support program.
Advanced care Planning On September 1, 2011, advance directives became another new legal option for capable adults in British Columbia to do advance care planning to make their wishes known for their future health care treatment decisions.
Advance care planning is the process of thinking about, and writing down, your wishes or instructions for future health care treatment in the event you become incapable of deciding for yourself.
In February 2012 the Ministry of Health published a guide to advance care planning – My Voice
To downlod a leaflet about advance care planning click here An advance care plan can be one of the following four options:
- A Basic Advance Care Plan: a written statement of your beliefs, values and wishes, with a contact list for people who could be your potential Temporary Substitute Decision Maker.
- A basic advance care plan, plus name a Representative in a Representation Agreement; the representative will make health and personal decisions for you.
- A basic advance care plan, plus make an Advance Directive. An Advance Directive is a capable adult’s written instructions that speak directly to their health care provider about future health care treatment.
- A basic advance care plan, plus name a Representative in a Representation Agreement and make an Advance Directive.