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Meeting the need for palliative care – a regional challenge

Managing Community Palliative Care, Hospital in the Home and Community nursing at Echuca Regional Health, Katherine Formica is responsible for community palliative care services to the 4,500 Victorians in the 36,500 square kilometer service all year round – even during the holidays.

“Based in Echuca we work over six local district nursing areas, sharing care planning with local health workers and travelling from one end of region to the other over 150 kms apart,” she says.

A typical day can involve several home visits in different towns providing immediate or ongoing treatment from palliative and home nursing, detailed referrals to other services and professionals, obtaining prescriptions, medication and equipment, briefing of family in their use, and personal care if needed.

Length of visits can’t be predicted, often resulting in shuffling or postponing scheduled appointments, or adding more urgent cases into the schedule that come up during the day, .

With 60-70 patients registered at any one time our workload consistently exceeds our current staffing level “It’s rare when any of us leave on time any day of the week,” Katherine says.

Increased referrals from better local medical and hospital care

“We have implemented an excellent early referral system with local GPs and specialists, but we occasionally get some very late referrals from metropolitan tertiary hospitals for people who wish to come home to die. Eighty percent of our work is cancer related, with the remaining 20 percent for end stage chronic illnesses.

“Our workload has increased over the past year due to the local hospital introducing specialised cancer services.  Instead of patients having to travel to Bendigo, Melbourne or Shepparton, they’re now linked to local services.  Whilst this has increased our client numbers, it has been a very positive step for the community and provides a much needed service closer to home.

“It has also attracted much needed cancer care expertise to our rural area.”

Many people requiring palliative care have complex needs. This involve liaison, co-ordination and consultation with the patient and family members, with local district nurses and GPs, pastoral carers, the regional Palliative Care Consultant, and Melbourne specialists.

Developing an effective and achievable advance care plan can take many hours, often spent around a kitchen table in the patient’s home.  Home visits, medication delivery and telephone supports supplement the family care, whilst ensuring a peaceful death at home.

Skilled staff a bonus for the region

“We’re incredibly fortunate that three of our four part time nurses have post graduate qualifications in palliative care and oncology, and one is studying bereavement counselling this year.

“Our team worked very hard on implementing quality bereavement services in our community.  We’ve developed bereavement care and support services based on the standards set by the Australian Centre for Grief and Bereavement.

“We’ve established a well-attended monthly bereavement walking group and are now training a volunteer to take over the running of this initiative.

“Over 100 family members and carers attend our annual bereavement service held in Palliative Care Week.

“Unfortunately there remains an unmet need for more bereavement counselling in our area but as our resources are focused on meeting the heavy workload caring for palliative care patients, there is only so much we can do,” Katherine says.

Work to be done on palliative care for people with dementia

The Palliative Care team rarely see any end of life dementia patients: “There’s only been one referral in the last four years with dementia, in an aged care facility (ACF) where staff needed assistance guiding the family through the terminal stage of their relative’s illness.

“Investigating palliative care services for patients with dementia is definitely on our plan this year.”

Katherine and her team also want to further develop relationships with aged care facilities.

“Two years ago we knew we weren’t getting referrals from aged care facilities so we began to visit them, making ourselves known to their staff and explaining how palliative care worked and how it could help their residents.

“Our team members live and work in a small community. In Melbourne you can leave your work behind you when you go home but here we constantly see the families and friends out of hours when shopping, dropping kids off to school or at the local footy.  Whilst this can be challenging, we know that everyone’s interested in the welfare of our patients which brings us closer together as a community.

“Yes we are very busy, but our team is also incredibly dedicated. We absolutely love what we do and we are very proud of our jobs.  We feel privileged to serve our community in the way that we do,” says Katherine.

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