Anna H Pissarek, Project Coordinator/Public Relations, and Sigrid Beyer, Project Manager, Hospice Austria, the national association of about 300 hospice and palliative care institutions in Austria, explain the background to their longer article that is published in the November/December issue of the European Journal of Palliative Care.
Organisations running nursing homes were, so to speak, queueing at our doorstep when we, Hospice Austria, started our project of integrating hospice and palliative care in Austrian nursing homes in 2006. What is behind this obvious need?
We found a combination of several reasons such as: a higher percentage of very old residents suffering from dementia and/or other life-limiting co-morbidities, a decreasing percentage of qualified nurses, being faced quite frequently with ethically difficult decisions, and non-existing medical care (let alone geriatric palliative/medical care), especially at weekends and during night shifts. Based on the experiences of homes with similar concerns we developed guidelines, which became the foundation for a two-year organisational development process, including a training in palliative geriatrics for 80% of all staff.
Let’s listen to a nursing home and a team of facilitators talking about the impact of this process.
Viennese nursing home, 2014
«An important result … was that insecurity about legal questions and a lot of anxiety about ‘Are we doing the right thing?’ have disappeared. Our staff now act with more confidence, family members are also involved much earlier in decision-making and decisions are documented. … What we also want to stress is how this has led to a change in practice and attitude. For example, transfers to hospitals have decreased and our staff are more comfortable about accepting that intensive medical care is replaced by palliative care, especially pain treatment…»
A palliative care doctor and nurse, co-facilitating the training in several nursing homes 2014
«On the first day of a training course we love the lively discussions following our question: When does someone need palliative care? When does it start? The insight that palliative geriatric care starts with someone’s admission to the nursing home often comes as an aha moment. This is especially so when participants understand what admission means to new residents as they are confronted with physical disability caused by their often multiple incurable diseases, and the grief of leaving behind all that was familiar to them. During the weeklong training, participants realise once more how much patience and empathic attention people need, as their sense of reality and personal identity decline because of dementia and increasing fragility.»
The picture shows ‘Mrs Hilde’, a newly admitted resident of the nursing home. At the beginning of the weeklong training, the participants create three characters: a female resident (most residents in nursing homes are female!), a member of her family and her (main) carer. In the story of ‘Mrs Hilde’ and her family and carers – from admission to the nursing home until her death and beyond – all important topics of palliative geriatrics are covered. This so-called storyline method is excellent for groups with a very diverse learning background (from doctors and nurses to kitchen and cleaning staff).
The two-year project has made a difference to nursing homes – but there is still a long way to go. Financial restrictions, the continuing lack of legal clarity, and a rather high staff turnover are some of the challenges nursing homes have to face when trying to sustain what has been achieved, and to fully embrace hospice and palliative care for all involved: residents, carers and family members…
This post relates to a longer article, ‘Introducing hospice and palliative care to nursing homes in Austria’, by Sigrid Beyer and Anna H Pissarek, published in the November/December 2015 issue of the European Journal of Palliative Care (vol. 22.6).If you have a web-based subscription to the journal you’ll be able to download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.
EJPC Palliative Care Development Award 2016 – nominations form now online.
Do you know someone who has made a major contribution to palliative care policy development? Why not nominate them for the EJPC Palliative Care Policy Development Award? Launched by the European Journal of Palliative Care in collaboration with the European Association for Palliative Care, the award is aimed at professionals working in palliative care worldwide who have made a substantial contribution to policy development through research, clinical practice or as policy activists. The 2016 Award will be presented at the 9th World Research Congress of the EAPC in Dublin, Ireland (9–11 June 2016)
Deadline for applications: 31 March 2016.