Sub-theme: Models of care – implications for the future: Developing effective partnerships

Title: Palliative Aged Care Supportive Service, enhancing partnerships for quality care for elderly

Northern Sydney Local Health District (NSLHD) has the highest proportion of residents aged 80 years or older in NSW. The percentage of the population aged 65+ years is expected to rise to 53.7% by 2041 in NSLHD. Accordingly, this geographical area has a relatively high number of Residential Aged Care Facilities (RACFs) with over 120 facilities providing over 9,000 beds across the LHD. 

 

A Nurse-led model of care (MOC) known as the Palliative Aged Care Supportive Service (PACSS), is provided by nurse practitioner & transitional nurse practitioners who are based in acute hospitals. The aim is to ensure continuing and seamless delivery of palliative care for people as they transition from acute hospitals to RACFs. 

 

This MOC has enabled strong partnerships with RACFs, outreach geriatric teams and other community services within NSLHD. PACSS provide direct clinical care and facilitates case conferences while establishing the palliative care needs rounds and family webinars. These initiatives have helped to build relationships and assist with care provision to those individuals who are identified as having palliative care needs or are at the end of life. 

 

The continuing collaboration with the geriatric outreach teams has also helped reduce preventable hospital admissions, timely prescribing of symptoms management medication and deprescribing for people approaching the end of life. Collaboratively care enhances strong partnerships with RACFs, outreach geriatric teams and other community services. This strengthens the aged care staff’s knowledge, skills and confidence in providing palliative care, assisting a greater number of older Australians to die in their preferred place surrounded by comfort and support. 

 

As palliative care becomes an essential component of aged care services in Australia, partnerships ensure that care is responsive to the needs of older Australians. PACSS will endeavour to strengthen this collaborative approach to meet the challenges of providing palliative care in aged care.