Navigating the Final Journey: Dying in Residential Aged Care in Aotearoa New Zealand

Abstract

A major concern created by an aging population in New Zealand is the impact on the demand for health and disability services. New Zealand statistics project that the aging population of people aged 65 years and over will more than double in the next decade. This has implications for palliative care providers including hospices and hospitals because long-term inpatient care is not generally provided by hospitals and hospices. When dying patients need long-term care, residential settings become an option. The level of palliative care in these facilities is dependent on staff training and numbers. In general, staff are not trained in palliative care, neither do they provide the multidisciplinary facets that define palliative care as undertaken by hospices. This paper describes a practice development initiative using storytelling as the vehicle for introducing the concept of the Liverpool Care Pathway (LCP) for the dying patient into residential aged care settings. With the emergence of a reflective paradigm in nursing the concept of storytelling as a teaching/learning tool has grown. Many staff in residential care settings come from diverse ethnic backgrounds where for some, English is their second language. Storytelling therefore can be a useful approach for learning because it can increase their communication skills. The Liverpool Care Pathway for the dying patient is a model that can be translated across care settings, hospice, hospital, and community. It can demonstrate a framework that facilitates multiprofessional communication and documentation and embraces local needs, culture and language to empower health care workers to deliver high quality care to dying patients and their family/whanau and carers. Successful implementation of the LCP into residential aged care settings will benefit from a robust process of engagement where the object is to develop a relationships with stakeholders, communicate effectively, problem solve, or bring about change. This paper will also explore the role of a facilitator as an agent of change and discuss how the interplay of evidence, context and facilitation can result in the successful implementation of the LCP into residential aged care settings.