ABSTRACT

All of the people we care for have a primary diagnosis of dementia with behavioural and psychological symptoms that are not able to be managed in a mainstream Residential Aged Care Facility, and determining their wishes is a common challenge. As residents are admitted to our facility and this becomes their new home, it is common for them to experience an increase in distressing symptoms. The information needed by staff includes situations that may cause them distress, the behaviours they exhibit when distressed, and the strategies that will ease their distress and keep the resident and staff safe.

We designed a document titled "This is me..." to capture this vital information. The information is gathered from families, former facilities, observation and, where possible, the resident themselves. This information is written on one page in easy English, without medical terms or acronyms so that all categories of staff can read and understand. It is written in the first person, as though the person is telling staff first-hand what their experience is. This builds a person-centred approach and provides a valuable insight into the person.

PRESENTER BIO

Cathy Wynn is the Nurse Manager for Staff Education and Clinical Practice at Garrawarra Centre, a residential aged care facility owned by NSW Health and part of South Eastern Sydney Local Health District. She has a strong interest in Education and Dementia care. She enjoys positively influencing staff to provide exceptional person-centred care and is proud of her team of Educators, as well as the clinical staff who provide care.

VIDEO ABSTRACT

ABSTRACT

Background
During 2020, Victoria experienced rapidly rising COVID-19 numbers, which quickly spread into Residential Aged Care Facilities (RACF). Eastern Health in Melbourne developed an innovative model of care for residents with COVID-19 who could not be safely managed in their RACF due to behavioural and psychological symptoms of dementia (BPSD). The COVID-19 Supportive Care Unit (SCU) was created by transforming a subacute ward and staffed by a multidisciplinary team.

Aim
Investigate the strategies implemented to manage a cognitively vulnerable cohort with high risk of BPSD and subsequent prescription of psychotropics.

Method
Chart reviews were conducted for the 51 residents admitted to the COVID-19 SCU. Psychotropic medications were reviewed on admission, day 7 (thought to be the peak of illness severity) and discharge.

Results
69% of residents who were admitted with regular psychotropics achieved deprescription. Two patients required code grey responses and only 32% of residents required PRN psychotropics for BPSD. Adverse effects were not increased as a result.

Conclusion
Effective implementation of non-pharmacological strategies and multi-disciplinary geriatric care allowed the safe deprescription of psychotropics for RACF residents with COVID-19 who were at high risk of worsening BPSD. These strategies can help to guide future models of care.

PRESENTER BIO

Nicola Hogan is a 2nd-year Geriatric Medicine Advanced Trainee currently working in Victoria. She completed her Basic Physician Training and 1st year of Geriatric Training at Eastern Health. During the 2nd COVID-19 lockdown in Victoria, Nicola worked on the COVID-19 Supportive Care Unit designed to care for displaced COVID-19 positive residents from RACF with dementia and resultant behaviours that could not safely be managed or adhere to isolation measures. She is passionate about improving the lives and management of people living with dementia.

VIDEO ABSTRACT

ABSTRACT

We hide the last stage of life, death and dying, from view. As a society, we don’t acknowledge, plan for or talk about the last stage of life. The system today is fragmented, fractured and focused on clinical interventions for the person who is dying. Non-clinical needs are insufficiently addressed, and the people around the person who is dying (carers, family members & relevant workforces) are underserved.

After analysing 500 guided support case notes and thousands of instances of digital support, Violet has identified 5 non-clinical gaps in the last stage of life.

The needs in the last stage of life for families and caregivers of those living with dementia closely align with those Violet identified in their recent research, they include acceptance and communication. These have been validated by a recent study published by BMC Geriatrics.

Violet has found that not only do aged care staff feel under-supported in areas of non-clinical end-of-life support, they experience moral distress related to it.

A 12-month pilot has seen Violet roll out training to key Dementia Services Australia (DSA) consultants nationally alongside targeted support programs for caregivers and families to address these misperceptions and improve communication and support around end-of-life.

Insights from the pilot include carers and families feeling a greater sense of “acceptance and clarity”, while DSA staff are “feeling like they're being heard, that their work and the complexity that they sometimes face is being understood and that they're not alone.”

Violet is working towards a future where the aged care workforce feel they have the skills and support to safely enter into end-of-life conversations with families.

PRESENTER BIO

Melissa Reader is the Chief Executive Officer of Violet, an Australian not-for-profit providing free support through the last stage of life, and the grief that accompanies it.

ABSTRACT

There is a strong and growing advocacy to improve access to high-quality palliative care and end-of-life care for older people in residential aged care homes (RACHs) in Australia. In 2019, the Australian Royal Commission into Aged Care Quality and Safety acknowledged that the fragmented palliative care for older people in RACHs creates unnecessary distress for both the dying resident and family members. The “Quality End of Life Care (QEoLC) intervention” included palliative care education, training/resources, monthly Needs Rounds to detect residents at risk of dying, mentoring by a palliative care clinical nurse consultant, and use of Palliative Care Outcomes Collaboration (PCOC) tools for assessing resident needs. Staff from two Australian RACH sites participated in the intervention during 2020-2021. Evaluation included: Pre-Post surveys, after-death audits and semi-structured interviews with RACH participants. The presentation will provide a selection of evaluation findings. Key findings: a) Healthcare workers in RACHs can be trained to identify, assess and discuss residents at risk of death and deterioration and their needs; b) Interviewed participants reported achieving positive outcomes for residents including use of appropriate medications, initiation of timely pain management, discussion with families regarding end-of-life care issues and avoiding unnecessary hospitalisations.

PRESENTER BIO

Professor Melanie Lovell is a Palliative Medicine physician and Senior Staff Specialist with HammondCare in Northern Sydney, currently working at Greenwich Palliative Care Unit and in the Greenwich Community Palliative Care service. She is a senior academic in HammondCare’s Palliative Centre. She has appointments as Clinical Associate Professor at University of Sydney and Adjunct Professor at University of Technology, Sydney. Her research interests include health services research and implementation science.

VIDEO ABSTRACT

ABSTRACT

The Advance Project is funded by the Australian Government and its purpose is to build capacity of aged and primary care professionals to provide better care through initiation of advance care planning (ACP) with people living with different stages of dementia and systematic assessment of their palliative care (PC) needs. In 2021, eleven new dementia-specific resources and tools for clinicians, careworkers, managers working in residential, home/community and primary care settings, people living with dementia and their family has been developed. Online training modules explain how to use these practical resources to enhance care.

This presentation will focus on introducing The Advance Project (Dementia) Guide, a simple framework that will assist aged and primary care professionals introduce ACP and assess PC needs of a person living with dementia. At the conclusion of the presentation, participants will be familiar with resources and training available through the project including tools for: a) initiating ACP with people living with early or moderate dementia; b) initiating ACP with families of people living with advanced dementia; c) assessing PC needs of people living with dementia. The online training, resources and tools are freely available for registered participants through the project website www.theadvanceproject.com.au.

PRESENTER BIO

Professor Josephine Clayton is a Palliative Medicine Physician at HammondCare’s Greenwich Hospital in Sydney and Professor of Palliative Care, Sydney Medical School, University of Sydney. She is also Director of Research & Learning, The Palliative Centre, HammondCare. Josephine has extensive clinical experience in providing palliative care and discussing advance care planning with people with a variety of chronic/debilitating conditions. She is the Director of the Advance Project, a National program funded by the Australian government which provides training/support for clinicians in aged and primary care to initiate conversations with their patients about advance care planning and palliative care.

Jon San Martin is a registered nurse with experience working in residential aged care and the specialist palliative care service. Jon started his nursing career as a care worker in a retirement village before undertaking various roles as a registered nurse in aged care. As the clinical nurse educator in the palliative care unit, Jon led several quality improvement initiatives. He is a mentor for the Program of Experience in the Palliative Approach and was an Advance Care Planning facilitator for Decision Assist. He is currently working as the Clinical Nurse Consultant for The Advance Project and at the Palliative Centre, HammondCare.