Palliative Approach and End of Life Care

Diagnosis of malignant illnesses like cancer usually results in a short period of decline that begins and ends in acute care (Vans, Law, Turner, Rodgers, Cohen, 2011). For those individuals living with the life-limiting diseases like dementia, the progression of the disease is gradual and not easily reversible. The patients with these illnesses may just need occasional access to the specialist Palliative Care instead of relying on the primary care providers like the general practitioner to offer ongoing support for psychological, physical and social problems that are unique to the nature of the illnesses they have (Spellman, Griffith, Huefner, 2010). Most of the patients, aged and young with these life-limiting illnesses usually reside in the Residential Aged Care Facilities (RACF). The medical care offered in Australia prioritizes in treating diseases as well as preserving life as well as providing care at one’s end of life. This analytical paper aims to give an insight and critically analyze the various models of health care service delivery for older people that involve the palliative approach and the end of life care (Mitchell, 2009).

The Palliative Method usually targets improving the health standards of life for persons having diseases which threatening life and their families by aiming at  decreasing the distress via quick identification, evaluation as well as the pain treatment, psychological, physical, social, cultural and spiritual needs (Australian Medical Association, 2016). In health, End of Life Care is used to refer to the care that is given to patients not only in their final hours or days but also the broad care for all the persons with a terminal illness as well as other terminal conditions that develop, advance, progress and become incurable (Australian Commission of Healthcare, 2017). The end of life care ranges from the decisions, including the issue of palliative care, patient’s right to determine their treatment, medical research procedures, the ethics and the efficacy of the dangerous medical advancements, and the ethics involved in the continued standard medical interventions. The end of life includes issues on rationing and allocation of various resources in the hospitals as well as the national health systems. These decisions are informed by the technical, economic factors, medical considerations, and bioethics. The end of life care is usually subject to factors to the patient autonomy. It is up to the patient and family members to determine when aggressive treatment needs to be pursued or withdraw the life support mechanisms.

The Commonwealth of Australia via the World Health Organization (WHO), the state as well as other territory governments across Australia have improved and increasing their efforts that are focused on improving the palliative approach and the safety as well as the quality of the end of life care (Sharda, 2005). These institutions promote the care for the aged population through funding, promotion of health education, formulation of policies and setting the standards for the palliative care approach and end of life care (Australian Commission for Health, 2017).

The Australian Governments offers to fund for many projects aimed at enhancing knowledge in palliative care while providing the skills necessary for the health of the aged care workers, and promotes awareness of the end of life choices (Australian Government Department of Health, n.d). The Australian government in conjunction with the WHO have come up with various programs that are aimed at improving the palliative approach. WHO defines palliative approach as the method that is used to promote the quality of life of the sufferers as well as their families who are encountering various problems that are associated with the life-threatening illnesses by preventing and relieving their suffering by early detection, impeccable evaluation and the diagnosis of the pain and solving of the spiritual, psychological and physical problems (Barp, 2005). These mechanisms involve models of wellness, case management, and user-pays to promote active aging.

Discussion

The National Palliative Care Strategy of 2010 is aimed at supporting all patients to live healthy at during End of Life. This strategy strongly represents the joint efforts of the Australian government, the state and the territory governments, community-based organizations and the palliative care service providers towards the development and the implementation of the palliative care programs plans and the services that are always consistent across Australia (URBIS, n.d).  The approach has four primary goals; the first one is Awareness and Understanding. The strategy aims at the improvement of the appreciation of death and dying by accepting that this is a normal process and that it is part of life continuum (URBIS, n.d).  The approach enhances the community and the professional awareness of the benefits and scope as well as to access the palliative care services. The second goal is effectiveness and appropriateness which ensures that proper and active palliative care is available to all the Australians based on the various needs (Moore, Petterson, Nair, Oliver, Brown, Keating & Riva, 2015). The third goal is governance and leadership to support proactive, collaborative and efficient management of the national palliative care approaches, resources, and different strategies. The fourth goal is the capability and capacity aimed at enhancing and building the capacity of all the relevant sectors in the health as well as the human service to offer quality palliative care. The government of Australia has a health policy based on the leadership role in the palliative care and also provide financial support to territory and state governments to enable them to operate the palliative care services as part of the health as well as the community service responsibility provision. The government also is involved in the funding of various National Palliative Care Projects that focuses on the training, education advance care planning and quality improvement (Draper, Melding & Brodaty, 2005).

The different policies on the palliative care outline the application and practice guidelines and requirements involved in the application of this approach to models of case management, wellness, active aging, and user-pays. Palliative care offers the liberation from various forms of discomfort and other upsetting indications (Hindle & Coates, 2011). The approach upholds life and regards death as a normal process that is inevitable hence there should be no efforts to hasten or postpone death but emphasizes on the integration of the psychosomatic and the psychic part of the patient care. The approach gives a provision mechanism which assists the patients to live active lives until death (In Farmer, 2012). The family is also assisted in coping with the patient’s disease and the bereavement. The Palliative care encourages the use an approach promoting team work and that addresses the various requirements of the patients as well as their families which include bereavement counseling. The strategy enhances the excellence of life and influences the course of illness in a positive way. The palliative approach enables active aging as it is applicable early in the process of the disease (Finch, 2004). In conjunction with various other therapies, the method prolongs life such as radiation therapy or chemotherapy. This approach calls for the investigations that are needed to enable better understanding and management of the distressing clinical complications.

Definition of Palliative Approach and End of Life Care

The current size and increase of elderly patients mean that they will create a challenge for the healthcare delivery system. Patient Survivorship for the care of the growing population has to entail late and long-term effects of the disease and the expected changes in the status of the old person that occurs with aging. Specific age chronological vary in regards to the ability to handle stress, cognition, and functionality. Although the assessment process starts with chronological age in the process of evaluation, additional tools are necessary to understand the proper care and attention for the needs of an individual (Australian Institute of Health and Walfare, 2012). For reforms in the delivery of aged care services, there needs to be a reformed system at the healthcare level as opposed to individual care setting. A more systematic and central approach is necessary so as to ensure management of flows in demand, and also ensure that the care setting is mixed with health catchment areas. Combining the different settings of the healthcare systems (optimizing healthcare) ensures that patients get the right care at the right time. Some context may require an increase of capacity and investment (Guah, 2011).

Consumer responsibility and empowerment can also be used a strategy for reform in the delivery of aged care. Customer segmentation methods can be applied to ensure that there is an understanding of consumer behavior, thus correctly implementing suitable user-friendly strategies. Such efforts can be more focused on driving positive behavioral change, thus used as a preventive method (Tavana, 2017). The health status of a person can be utilized as a means of segmenting the population. Consequently, thus ensures that the burden of disease is reduced, while the demand on the health system is slowed down. The objective would be designed to lessen the demand on the healthcare while consumers achieve healthier pathways compared to before (Information Resources Managemnt Association, 2016).

Wellness and prevention need to be carefully considered in the application of the palliative care approach and end of life processes. The multifaceted, complex and the interrelated factors that are usually driving the health care demand in some situations are way outside the ability of the government or other players in the healthcare system control (Care Search palliative care knowledge network, n.d). The demand of the healthcare system is usually influenced by the region demographics and the disease burden (Hovenga, 2013). The healthcare affordability is the most crucial driver of demand hence the government policy makers and the health funders influences directly. Affordability narrows the gap that exists between the actual demand and the latent demand. This ensures that the significant demand is not deferred which would result into later, costly and complex demand due to the worsening of the conditions if they remain untreated. This deterioration of the situation has adverse effects on all the stakeholders as more funds are required hence the burden on the individual, the family, community, the government and the international organizations.

The models of health service delivery among the aged are aimed at offering the required medical interventions. Case management in the palliative care is intended for the development of modules that are needed in the case management for nurses and involves the palliative care assessment, the identification, implementation and the various approaches to physician feedback. The case management module provides formal palliative care assessment which contains structured feedback as well as the different recommendations for the health care professionals whose patients have been enrolled in the multifaceted palliative care management program. The module compares the different outcomes of the interventions patient getting palliative care evaluation and case management. This is compared against control patients who are receiving management on a standard level. The model evaluates the feasibility and the acceptability of the case management module to the patients, caregivers, family members, the health professionals as well as the industry.

National and International Palliative Approach and End of life Projects

Population advancement in age raises numerous fundamental questions and issues for the policy makers. These questions are directed to help people remain self-sufficient sas they age. This model contributes to strengthening the prevention and health promotion policies among the older generation. The module ensures that the quality of life in the old age is improved. The model outlines guidelines on how the government should handle the various sources of elderly care funding so that a high population of older individuals does not bankrupt the health care as well as the social security systems. The model calls for balancing of the role of the state and the family in caring for older persons to enable active aging. The government’s decision-making process actively affects the wellbeing and graceful as well as improved old age quality of life. There are various rationales and concepts for the active aging a goal in the policy and also program formulation.  The individuals who can pay for the services for the aged are required to pay. However, the government helps the other older poor persons to cater for the financial duties in aged care services.

The public focus on the Australia’s health care structure is majorly around the issues of how to provide high-quality, affordable and accessible aged care. The Australian government has formulated a health system which serves the older generation well as compared to the various key indicators to the overseas health systems. However, the government and other policy makers have room for improvement of the service delivery in aged care. There are various Commonwealth government interventions in aged care that include funding, regulatory mechanisms, research and other development approaches. There is a broad range of national machinery aimed at promoting and enhancing the quality of health care among the aged population. From a philosophical position, the objectives, and vision statement of various stakeholders have put in place various mechanisms of delivering aged care services needed in the palliative approach and end of life settings (Hovenga & In Grain, 2013). There is promotion of different policy, for instance, the Hardi Aged Care policy that promotes goodwill among the residents, relatives, health workers as well as the wider community.

For the elderly individuals, ethics is all about how they want to be treated and handled by allowing them to make their decisions. For the caregivers and the family members, ethics revolves around doing what right all the time even when there is no one looking is. For the various professionals providing the aged care ethics is all about the adherence to the set canons of ethics propagated by various ethical organizations. The ethical issues range from conflict of interests, confidentiality, and the decision-making capacity. From a legal position, there are various mechanisms aimed at preventing elder abuse (Aras, 2017). The Elder abuse and the law safeguard the elderly from unfair treatment. The duty of care is based on a reasonable bystander’s perspective founded in the law of negligence. Conduct that is considered reasonable is the one that is acceptable, fair, honest, fit, proper, right, equitable, tolerable, average and within reason (Aras, 2017). All the staff in the residential facility are required to show the skills and the ability of a competent health worker in every solution. The duty of care embraces the rights of the aged concerning independence, dignity, and self-determination (Aras, 2017).

Application of Palliative Care Policy and Practice

All the citizens of Australia are supposed to age gracefully and die with dignity as they are empowered to have much control over the various circumstances of their death which include the place of their choice. The Australian government and other national and international stakeholders fund various activities in palliative care aimed at improving the end of life care. The palliative care is usually marked differently from the ordinary medicinal method that concentrates on eliminating the illness and protecting life. As discussed above, the health sector have developed and implemented the National Palliative Care Strategy (Guah, 2011). Various pointers have been put in place for an effective palliative approach that is funded by the government and other stakeholders in the different aged care systems. However, shortcomings and key issues should be immediately addressed in the provision of the services of palliative care and end of life care to the older Australians. The government sources for financial support through the formation of various national and international alliances to fund residential care facilities to improve the palliative care and the end of life care (Sharda, 2005). These associations support the definitions and the different elements that the palliative care describes. The alliances claim that the delivery of quality palliative care can only be realized if an active network is present between the palliative care professionals, primary specialists, primary generalists, the support care providers as well as the community as a whole working as a unit to meet all the needs of all the people.

The nature of aged care services ensures that they are provided towards the end of life, dying and death are not uncommon to aged care. However, the provision of excellent palliative care in the community care and the residential settings is the exception instead of a norm. The conversations involving death and dying is an ad-hoc, it remains a taboo. The systems such as dysphasia and pain are usually poorly managed (Mitchell, 2009). The end of life processes like anorexia, dehydration and respiratory failure are also sometimes treated as medical emergencies thy may prompt hospitalization instead of normal constituents of an incurable illness that can be managed properly by the palliative care teams or by other staff with education and the clinical confidence in offering end of life care. The various financial arrangements in Australia for aged care leads to different outcomes for persons depending on place of residence. Poor, elderly people living in rural areas require more funding from the government. In WA, the government offers significant funds for the home palliative care via the Silver Chain. Because of the application of this service, WA has a low rate of persons that die in the hospital (Barp, 2014).

Conclusion

The aged persons in the population usually have terminal conditions that decrease the quality of life or may even lead to death. Most of these circumstances are not curable and result in loss of life. Therefore, death is inevitable hence preparations for the end of life should be put in place. The palliative approach is aimed at improving the quality of life of the aged persons and better the end of life processes. The government of Australia, national and international stakeholders including WHO have put many efforts in upholding the palliative care and end of life through funding and policy formulation. There are various strategies, policies and models that are aimed at improving the palliative care. There is many contemporary from legal, ethical, political and philosophical positions that needs to be understood and given much attention (Draper, Melding & Brodaty, 2005).

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