Strengthening a Palliative Approach in Long-term Care (SPA-LTC) is a way for your long-term care community to improve its capacity to offer a palliative approach to care, including:
Understanding the resident’s psychological, social, and spiritual needs: Having an early family care conference is an important way to understand and document a resident’s psychological, social, and spiritual needs and integrate them into the care plan. In a palliative approach to care, it is also important to reflect together on how these needs might change as health status changes.
Preparing the resident and the family for future changes: Advance care planning means that residents and families know what to expect and have planned accordingly. Resources like illness trajectory resources can be an important way to help residents and families understand what to expect.
Recognizing functional change or change in health status: Changes can happen very gradually. When a resident has lived in your community for a long period of time, it can be difficult to see how much they have changed. Assessment tools like the Palliative Performance Scale can help you attend to functional change and know when to renew conversations about a resident’s current and future needs.
Communicating with the resident and family when things change: It is critical to communicate effectively when things are changing. This includes planning care conferences when there are unforeseen or cumulative changes. Our family care conference resources provide the guidance you need to time these conversations well and improve their quality
Providing comfort care: The two most important outcomes of a palliative approach to care are comfort and quality of life. Holding regular comfort care rounds is a way to ensure that the resident’s comfort is actively considered and promoted throughout their illness, and especially during periods of significant physical change.
Providing sensitive bereavement care: When a resident dies it is important to express care and support for the family and the long-term care community. Our informational resources can help you support the family as they navigate practical considerations when someone dies. Finally, coordinating a debriefing session with members of the care team provides a way for the team to express a range of feelings, and to consider best practices.
Knowing when help is needed: Even when you have built good foundations for a strong palliative approach to care, you will still have questions and there will still be room to grow. We encourage you to build a community of practice that includes consultants, volunteers, and other resources within or beyond your local community.
Strengthening a palliative approach to care is an ongoing commitment.
We recommend using this 7-component approach as a starting point that you can build on.
|Elements of a Palliative Approach to Care||Indicators of Success|
|Palliative Care Champion Team||A palliative care champion team is established. The team is interdisciplinary and includes nurses and nursing assistants. The team is given adequate time to lead change in practice. The team is given adequate authority or leadership support to advance change in practice.|
|Staff Education |
More new resources for LTC coming soon!
|The leadership team has completed palliative care education. The champion team has completed palliative care education. Palliative care education is delivered annually to new staff cohorts. Staff members are not excluded on the basis of their occupational role.|
|Palliative Performance Scale (PPS)||The Palliative Performance Scale or a similar tool is used to document functional change at least quarterly. Staff members know who is responsible to complete it. A process is in place for making the care team aware of significant/cumulative change. Functional decline is tied to processes such as health assessment and family care conferences.|
|Family care conferences |
More new resources for LTC coming soon!
|The team is trained in a family-centred approach to care conferencing.The team is aware of resources they can use to support critical conversations about current or future health changes. The team does not wait until the last few days of life to discuss changes that will lead to the end of life. There is a plan in place for continued evaluation and growth in care conferencing skills.|
|Information about illness trajectories||Illness trajectory pamphlets or similar resources are included in family care conferences to support residents and families to understand what is coming.|
|A sensitive approach to bereavement||Members of the care team express care at the time of a resident’s death. The information needs of the family are sensitively addressed at the time of death, and an informational pamphlet is given as a reminder of the content of the conversation.|
|Comfort care rounds or staff debriefing meetings||New routines are implemented to support staff to improve a palliative approach to care. This may be in the form of comfort care rounds, which involve discussing the comfort and quality of life residents who are drawing near to the end of their lives. Or it may be in the form of or staff debriefing meetings, which involve a supportive, facilitated meeting with staff who cared for a resident following the death of that resident. The palliative care champion team leads these meetings or helps to choose who should lead them. The leaders use the meetings to support staff while encouraging quality improvement (what went well; what could have gone better).|
It’s best to begin by establishing a champion team that includes some of the most committed members of the interdisciplinary care team. Build early success by asking them what first step seems most achievable. Then, incorporate additional changes over time as your team’s skill and efficacy increases.
Many long-term care homes find that they can build these 7 elements into practice within a 12-month timeframe. After the first year, continue to strengthen your practice using our other resources.
A palliative approach to long-term care is about ensuring that residents and families can participate in decisions and avoid needless suffering.
As a health care provider, you play a crucial role in bridging the gap between resident, family, and system needs in a way that puts the individual first and elevates the quality of care provided.
Our program is about helping you use a palliative approach to care in long-term care that focuses on meeting health, emotional, physical and spiritual needs of residents.
Our resources are designed to help you work with residents and their families to develop care goals that will help ensure a good quality of life from entering long-term care until their death.
Our evidence-based resources are developed to help you cultivate meaningful care moments, even when you have to communicate bad or sad news.
Our communications tools empower health care providers to develop procedures and policies that can strengthen your palliative approach to care in long-term care.