【October 2017】3- Building Diversified Long-term Palliative Resources

HFT secretariat

The Hospice Foundation of Taiwan (“HFT”) started a series of palliative care in Long-term Care Facilities (LTCs) and has promoted it since 2014. This includes seminars throughout Taiwan and onsite visits to many LTCs to experience and understand firsthand the demands and difficulties. From the information collected, HFT has started the Long-term Care Palliative Workshop, hoping to provide professional educational courses to diverse professionals.

A Practical Workshop Combines Theory and Practice

The Ten-year Long-term Care Program 2.0 announced by the government clearly states the desire to “provide supporting services in communities to further the transition to palliative home care.” Hence, it is essential for LTC staff to equip professionals with palliative knowledge and skill. During the eight-hour course, it emphasizes what palliative care and Advance Care Planning are. The lecturers come from various palliative and long-term care backgrounds to share their professional knowledge and years of practical experiences, which appeal to the participants about the importance of palliative care in the LTC setting. Palliative care is an important trend, and thus, all LTCs and staff should start evaluating how they can also participate and provide the service within LTC.

The course design is based on different professional demands. For administrative managers, the course provides instructions to promote the concept of dying well and to take the initiative. For social workers, the course enhances their skills to better care and communicate with clients. For nursing staff, the course equips them with the necessary knowledge and skills to perform palliative services in the facilities; it also assists the nursing aides to build up their own awareness that they are also palliative care providers.

Each lecture is lead by professionals from that specific field, as they teach participants how to provide or promote palliative care in the facilities. With similar backgrounds, these participants are able to interact with each other on a more personal level and speak the same language.

Satisfaction rates 90% with the Course Design and Content

Part two of the course moves on to emphasize case studies. The participants gather actual caring experience when promoting palliative care in LTCs, including in care related to cancer, dementia, and chronic diseases. Participants are then divided into groups for discussion. Through the discussion topics related to the case background, physical and mental status and medical status, participants further share when they believe is the proper timing to receive palliative care and make medical decisions. Further, they share about how to accompany the case client at EOL, and how to offer spiritual guidance when needed under the three different premises as related to cancer, advanced dementia, and chronic diseases.

The two workshops had a total of 114 participants from 61 different facilities. The follow-up survey shows that more than 90% of the participants are “very satisfied” with the course content and lecturers. The case study design especially helps the participants to link what they have learned in their minds to what they feel in their hearts as an effective, experiential learning. Further feedback from participants indicate their desire to include ethical and law issues for terminally ill patients, grief and bereavement, spiritual care, and coping with unexpected death.

One thing worth mentioning is that palliative teams from local hospitals also attended the workshops and explained their available resources to LTCs. HFT has discovered that these workshops not only provides education, but also provides a link between local hospitals and facilities. LTCs can also gain more confidence once they understand that they are supported by hospital resources and further take the initiative to promote palliative care in LTC settings.

On-the-job Training and On-site Visits Proposed

Holding this practical workshop is merely one of HFT’s responses to the facilities’ needs. Clinical Bedside Teaching is the actual resolution HFT has proposed to fulfill LTCs’ demand. Professionals shall be invited to LTCs to provide face-to-face bedside teaching, so that LTC staff can learn palliative care skills directly from the professionals, and therefore, intensify the learning motives.

Pingtung’s Hsiao-ai Jen-ai Charity Home, Pingtung’s Genesis Social Welfare Foundation, and Taipei City’s Hao-ran Senior Citizens Home have all mad e this request and provided very positive feedback.

In addition, HFT has 86 contracted hospitals all over Taiwan, some of which have already set up cooperative palliative care agreements with LTCs. In the future, HFT will endeavor for more opportunities related to palliative on-the-job training and on-site hospice visits, so as to enhance the ability and confidence of the palliative professionals.

In response to the changes of medical surroundings and government policies like Long-term Care 2.0, aging in place, and home medical care, HFT’s future plan will not be limited to LTCs only because many LTC professionals are not stationed at one facility only, but also actively take part in home care and community care. Thus, HFT has set its long-term vision on building up the patient-centered community palliative care network. In the meantime, HFT shall continue to enrich and diversify the available palliative resources so that palliative care in LTC settings shall grow in both quantity and quality.