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Palliative care in nursing homes |
The World Health Organisation in 1990 developed the following definition of palliative care in relation to cancer:
The total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms and of psychological, social and spiritual problems is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families.
Many aspects of palliative care are also applicable earlier in the course of the illness in conjunction with anti-cancer treatment. Palliative care:
- affirms life and regards dying as a normal process;
- neither hastens nor postpones death
- provides relief from pain and other distressing symptoms;
- integrates the psychological and spiritual aspects of patient care;
- offers a support system to help patients live as actively as possible until death;
- offers a support system to help the family to cope during the patient's illness and in their bereavement.
Radiotherapy, chemotherapy and surgery have a place in palliative care, provided that the symptomatic benefits of treatment clearly outweigh the disadvantages. Investigative procedures are kept to a minimum.
But what about patients who don't have cancer but have actively progressive, far advanced disease with a relatively shortened prognosis? This includes patients with a variety of diagnoses such as AIDS, end-stage respiratory, cardiac, renal, and liver disease. Many of these patients are cared for in nursing homes, rest homes or even in their own homes. Do such patients receive the same palliative care resources as patients with cancer in a palliative care unit? Are resources in nursing homes adequate to provide a sufficient level of palliative care to patients who need it?
There is no doubt that nursing staff in nursing homes are keen to provide a high standard of care to their patients and their interest in palliative medicine is growing. What is needed is for the palliative care service and nursing home staff to join forces and share resources for patients with special requirements.
The common link between palliative care services and nursing home services is the GP. It is appropriate for GPs, nursing home staff, community nursing staff and palliative care staff to work together to develop optimum palliative care management for the elderly in the region, including examining the ethical issues in the palliative care of nursing home patients.
Following the Federal politicians support of the Andrews Bill opposing legalisation of euthanasia, it is now imperative that there is political support for more palliative care resources with adequate access for all Australians, whether they be in remote areas, under-privileged areas, nursing homes or belong to ethnic minority groups.
When palliative care standards are high, euthanasia is seldom requested. When it is, it is usually a cry for help that can be dealt with if the resources are there. The palliative carers may be challenged but are rarely unable to deal with the situation and always have a team of expertise to call on if required.
Andrew Binns (abinns@gmc.net.au) is the director of the palliative care unit at St Vincent's Hospital, Lismore, NSW, Australia.
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