All life stages need a plan: Palliative Care Week

Most people prepare for every stage of life, even having a birth plan, yet few plan for their death, says Queensland palliative care clinician Mel Wagner.

Ms Wagner, Lutheran Services’ Chief Clinician, is passionate about supporting aged care residents at the end of their life.

During National Palliative Care Week (May 19-25) Ms Wagner says thinking about death is neither morbid nor taboo but an essential part of life.

“Palliative care in aged care has undergone major changes,’’ she says. “Our teams consist of very skilled clinicians who are dedicated to the specialised field of end-of life care.

“When people come into residential care now they are older, more unwell and nearer the end of their lives.

“The ability to receive quality support at home is working, older people are staying independent for longer.’’

After 18 years with Lutheran Services, Ms Wagner this month stepped into the newly created role of Chief Clinician after leading the Nurse Practitioner pilot program at the not-for-profit aged care provider for three years.

With a career dedicated to geriatric nursing and double Masters in chronic disease and palliative care, and nurse practitioner studies, she is excited by the opportunity to grow the new advisory and management position across the group.

Ms Wagner says a key part of her role will be to continue the expansion of the nurse practitioner program across all Lutheran Services’ aged care sites and its home care service, supporting all clients, no matter what stage of life.

“A nurse practitioner takes a vital role when it comes to end-of-life care and supports clients and their loved ones in preparing for what is to come while working in collaboration with GPs and the wider health team.

“Not everyone wants to talk about their own death, but I stress the importance of having an Advance Care Directive or a Statement of Choice, and perhaps both.

“An Advance Care Directive is a legal document signed by a doctor, solicitor, or JP, while a Statement of Choice is more a values-based document that guides future health care decisions but is not legally binding.

“I encourage anyone entering aged care to consider an Advanced Care Plan and/or a Statement of Choice as part of their admission process. This paperwork ensures your family and healthcare workers know your wishes and can provide that extra special care you desire.

“It basically asks what is important to you at this time: what will bring you joy, such as your family, visits from your dog or your spiritual care. It also includes what is unacceptable to you, considerations for your dignity and if you don’t want any interventions at the end of life, such as CPR.’’

Ms Wagner says there are many positive things happening in aged care around palliative care, with a focus on personalised care and a family-centred approach.

“Palliative care is a very specialised field of nursing and we are embracing upskilling and training,’’ she says.

“At Lutheran Services we have had several services engage in the End-of-Life Directions for Aged Care (ELDAC, a national specialist palliative care and advance care planning advisory service) that has strengthened our links with local specialist services and provided high-level training for our teams.

“The Specialist Palliative Care in Aged Care (SPACE) team, run by Queensland Health, also offers us access to specialised palliative care for our residential aged care residents and their loved ones.’’

Ms Wagner promotes a “community of care’’ at the end of life, stating family are vital in the process.

“We encourage and respect family wishes, allowing them to be as involved as they would like to be.

“We aim to make it a positive experience for all involved, caring for everyone’s physical, emotional, social and spiritual needs.

“Having difficult conversations early with family ensures everyone in the community of care including the medical team are on the same page with the resident at the centre of the care provided.’’