Aged care workers confront death

Death is something we would rather avoid thinking about than be confronted with, but the truth is – we will all face that unenviable day at some point in our lives; and when deaths occur at aged care facilities it is often dealt with poorly by staff.

Aged care workers are encouraged to make death and palliative care part of their work process; they need to be aware of family attitudes and ideally be able to openly discuss the issue with families of residents . that death is likely to occur.

Molly Carlile, manager of Palliative Care Services at Austin Health in Melbourne, says aged care training should include palliative care, but there is yet to be in depth teaching on the difficult topic.

Aged care workers need to have ongoing professional development in palliative care, focusing on how to provide best practice of end of life care, and should be encouraged to explore their own views of mortality.

Resilience should be strengthened, according to Ms Carlile, who says workers need to know they are “not alone” in dealing with the death of a resident.

“As a community, we don’t do death well. We need to invest time and energy in front end, in health and promotion. If it’s done before, we’re not so scared of death when it happens. But the fear won’t change until community attitudes change,” she says.

According to Ms Carlile, when a person dies at an aged care facility, staff do not talk about it even though the other residents notice that a resident is absent “It’s like one day, they’re just gone,” she says.

However, she says some facilities are improving, with open conversations about death; but this process depends on the person in charge as it is not considered general practice at facilities.

Before aged care staff can open up about difficult issues such as death, they must, as morbid as it may be, work out what they think about their own death and dying.

“Staff has to be able to deal with their own attitudes to death first. They may have chosen to work in aged care for a reason, but it’s not normally because of the palliative care aspect. Staff must make death and palliative care part of their work process,” Ms Carlile says.

In order to be more informed about dealing with death, Palliative Care Australia’s chief executive, Dr Yvonne Luxford told DPS eNews it is vital that aged care staff are comfortable discussing it.

“They play an important role in supporting residents and their families through life and death and need to be able to openly discuss these matters so that they can provide the best possible care,” Dr Luxford says.

“If we aren’t comfortable discussing death and dying then this is going to affect the type of care that we receive at the end of life. All aged care workers need to be comfortable having these conversations, and a good way to do this is through advance care planning.

“Having these conversations with people within residential aged care will assist aged care workers in providing the optimal care for both the older person at the end of life, and their families, aligned with the resident’s wishes,” she says.

Training programs are available to help workers become better informed about death and dying in facilities. The Program of Experience in the Palliative Approach is one program where aged care staff can work alongside palliative care specialists to increase their skills in the palliative approach to care.

“The Guidelines for a Palliative Approach in Residential Aged Care is an excellent resource intended to help aged care workers, from attending to physical symptoms such as dehydration and fatigue, to dealing with the reactions of family members,” Dr Luxford says.

She says it is important aged care workers recognise that quality palliative and end of life care is best delivered using a holistic and multidisciplinary approach.

“It encompasses the physical, cultural, psychological, social and spiritual needs of the person and their family – it is not just treating their pain and other symptoms.

“Palliative care is not limited to the final days of someone’s life, a palliative approach is about helping people live well up until the point where they die, in an atmosphere of care and support.”

If you are an aged care worker, share your thoughts on this article. Do you find it difficult to talk about the death of a resident in your facility? Let us know what you think by commenting in the box below.