No matter if the patient is being cared at home or in a Long-term Care Facilities, the most important aspect is still the follow up.
Palliative care has been promoted in Taiwan for more than 20 years, and in those years, the idea and service of palliative care have received wide acceptance and recognition. And when it comes to clinical care, especially when a patient’s acute symptoms are stabilized in the hospital’s palliative wards, it is with increasing likelihood that the patient is transferred to the home environment or the elderly care facility. In such cases, the biggest concern for the patient and family is how to follow up on the situation.
Once the patient returns home, the palliative team can pay regular visits to provide palliative home care and ensure the patient receives continuous care. However, with the changing family structure and population, there is still a certain percentage of patients who cannot receive care at home, and thus, an elderly care facility becomes the common alternative for many. This also shows a new direction for community palliative care, that is, as it relates to bringing palliative care into Long-Term Care (“LTC”) facilities. Therefore, we endeavor to provide quality palliative care access to patients and elderly who require palliative care in LTCs.
According to The Overview Statistics of Taiwan Elderly Long-term Care and Nursing Homes published in June 2016, there are a total of 1,081 LTC facilities with a capacity of 60,578 beds; currently, they are caring for 46,462 elders with an occupancy rate of 76.6%. Until June 2015, there were a total of 501 general nursing homes and veteran homes to provide 43,402 beds, and the occupancy rate was 85.4%.
Based on these statistics, we can estimate that there are currently more than 80,000 elderly residing in these facilities. With the trend of the general population growing older, it is expected that this group of residency will continue to increase. Though these elderly are not necessarily terminally ill patients, but with inevitable aging and declining physical and mental functions, the palliative team should be involved at an early stage in order to effectively promote Advanced Care Planning. If the palliative team and LTC facilities can both build up a long-term partnership and start monitoring the physical and mental changes of the residents at early stages and interfere or refer proper resources and teams when needed, it would certainly benefit all parties.
However, actual clinical care is such that patients normally cannot receive proper care or have difficulties during the referral process to a new care facility. These are often due to the facilities’ overloading and lacking of resources and actual experiences. How to assist these elderly care facilities to ease their loading and the access of proper resources is the most crucial issue when developing palliative care in LTC facilities.
Under the current circumstances, if the patients in these care facilities have professional palliative assistance, the staff would have a channel to professional counseling. With this shared care model, it also helps the care facility to build more trust into the relationship. As the nursing aides in the care facilities are often under great pressure, it is vital that the same amount of attention and resources are made readily available. By providing professional palliative care training and caring skills, it can effectively lower the stress and frustration that nursing aides face and increase their willingness to devote themselves into palliative care.
Looking at it from the other side, the elderly care facilities will encounter many challenges while trying to include palliative care into their services, for example, dealing with the public’s acceptance of palliative care, devising the caring strategies, allocating resources, etc. Even the government and different policies will affect how far palliative care can reach within these facilities.
While palliative care is being promoted zealously into the community at homes and in elderly care facilities, the challenges that come along are often beyond expectations. Nevertheless, we hope with the participation of more professional teams and resources, we can push the development of palliative care in Taiwan one step forward, so that our beloved elderly can receive proper palliative care that provides for their bodies, minds, and souls.