Today we continue our focus on National Palliative Care Week with a look at a very important component of end-of-life care: enabling dying at home.
Supporting discharge from hospital to enable dying at home is a Gold Coast Hospital and Health Service initiative. Associate Professor Laurie Grealish from the health service said “older people are having more frequent admissions to ED as their disease [progresses]. I was curious about how we supported them if they did want to stay home. How could we help?"
Gold Coast Health staff are now working with stakeholders from the health service, non-government organisations, charities, and consumer groups to collaboratively develop, implement and evaluate a hospital discharge pathway for people near end of life to die at home. The outcomes from this project will help health services to provide people living with a life limiting illness and who are approaching the end of life, with more options about their care.
This project is supported by our second round of SEED (Support, Explore, Excel and Deliver) funding for 2018-19. The SEED funding program is designed to stimulate novel innovative approaches to the delivery of care as part of the Statewide strategy for end-of-life care. It’s part of Queensland Health’s commitment to ensuring all Queenslanders have access to safe and high-quality care at the end of their lives.
Associate Professor Laurie Grealish: The project that we're doing is looking at how we can support people who are not qualifying for specialist palliative care services. So older people generally with chronic illness, who are approaching end of life and are thinking that they might like to die at home. So our project is about what kinds of supports and processes have to be in place in order to help them to get home. Wherever the view and in talking with our community and our consumers, that the opportunity to be at home when you're dying around your family, the smells that are familiar to you the sounds that are familiar to you. It's quite a peaceful, and a pleasant way to get to be with your family near the end of life. The health service is really interested in what's the best interests of patients and their families. And so I think this is something that the health service is committed to doing. And I think it's a part of being in a community. So recognising that, whilst the health service has got the best and brightest equipment and the shiny equipment that that might not be what's necessary for people as they're approaching end of life. So I think that awareness means that they're committed to this project as well. My body of work is really looking at what happens to older people in hospital. And one of the things that I noticed when I first got to the Gold Coast, is that older people were having more frequent admissions to ED as their disease progressed. And I was curious about how we supported them if they did want to stay home instead of coming to hospital. And then I started working with the palliative care team. And the project emerged when we saw the opportunity for seed funding, just to think how could we help? It has evolved in the sense that, in my view, it was going to be a fairly straightforward process evaluation. So understanding what would need to be put in place, put it in place and see how it worked. But what I'm discovering is that tide of care is an area that doesn't have widespread understanding or shared understanding. So there's a lot of definitional work that needs to be done. A lot of people are carrying their own bereavement, some of them still carrying unresolved grief that they need to work through when they're coming on to our teams. So there's ah it's a very complex area to be negotiating and working in, but at the same time, very valuable in the sense that people do feel that they're making a difference. I think we could definitely give some advice about the steps to take to set up a service like this, and the considerations that need to be undertaken within the organisation, and I think it's about I call it getting your ducks lined up in a row. It's understanding which ducks are most important and then getting them all on the same page. So we can give definitely give advice about that. So other services could do this as well.
For more information on care at end of life:
- For patients, carers and families
- For clinicians
- Subscribe to the care at end of life newsletter
- Contact CareAtEOL@health.qld.gov.au