【January 2017】2- Creating a Customized Environment for Palliative Care in Long-term Care Facilities

HFT secretariat

The theme of the 11th APHC (2015) hosted by the Hospice Foundation of Taiwan (“HFT”) was Transforming Palliative Care, which anticipated that the palliative care network might be truly implemented. Furthermore, the conference emphasized that a good death should be ensured in local communities in a way that the palliative ward, home care, and community care can all work together very efficiently.

The Taiwanese government is currently promoting Long-term Service Care Program 2.0, and encouraging long-term care facilities to join and promote the so-called palliative care in long-term care settings. However, long-term care and palliative care have always been categorized under two different systems, and therefore, lack interaction and coordination. For example, the current long-term care training course supervised by the Ministry of Health and Welfare does not provide any palliative training. The same lack of palliative training applies also to long-term care training courses from other organizations.

HFT proposes the following four steps to help bridge the gap between palliative care and long-term care:

I. Expand the Palliative Service to Long-term Care Facilities

Since last year (2015), HFT has organized palliative courses targeted at long-term care facilities’ staff, and made palliative care in long-term care settings as top priority. As a result, HFT has developed mid and long-term plans intended to expand palliative services to long-term care facilities. Furthermore, HFT has connected with related palliative societies, organizations, and associations, hoping to echo the government’s current policies and promote palliative care in long-term care settings.

So far, HFT has held four lectures throughout Taiwan to discuss the palliative needs for long-term care facilities, and understands first-hand the current predicaments they are facing as well as acknowledging future requirements. With these lectures, the hope is for HFT to deliver a diversified palliative care proposal that fits various long-term care facilities.

II. Integrate the Four Palliative Care Needs in Long-term Care Services

From the feedback received, HFT has concluded the following four as the most crucial:

  1. Improve the administrator’s palliative care knowledge and practical experience;
  2. Continue educational training for professionals (i.e., nurses and social workers);
  3. Initiate educational training for local and foreign nurse aides;
  4. Assist remote areas that have no or scarce palliative resources with their own local palliative teams.


Amongst these four, attention has been focused mainly on the knowledge of hospital administrators and managers and on the educational training of nurse aides (#1 and #3 above).

Although the public and private sectors both provide palliative on-the-job training courses, most facilities still lack executive power and incentive to promote palliative care in the institutions. By offering custom-made courses that can satisfy the requirements and demands for palliative care, HFT hopes to encourage more long-term care facilities to initiate palliative care. These courses include topics such as: palliative care for cancer and non-cancer patients, how to ready staff for palliative care service, clinical training, grief counseling, death education, spiritual care, how to cope with unexpected death, how to talk about DNR, and etc. The essence of these courses is to encourage the elderly to openly discuss their Advance Care Planning and help the facilities to fulfill the needs of the elderly.

III. Train the Trainer Strategy – a Practical Workshop  

In response to the needs of the long-term care facilities, HFT held three-day practical workshops around Taiwan in November and December 2016. The workshops included a keynote speech and four panel speeches in the mornings, as well as in-depth discussions in the afternoons. The topic of the keynote speech was “How to create palliative care in long-term care settings”, and focused on the facilities’ concerns about establishment and resources for setting up palliative care service.

The four panel speeches presented different professional viewpoints from administrators, nurses, social workers, and nurse aides, who all provided knowledge and skills required to promote palliative care in long-term care settings.

The afternoon discussions encouraged workshop participants to share ideas and experiences on how they overcame common difficulties through means of communication and education. Their valuable experiences might help others to locate the practical resources and new methods needed to promote palliative care.

Furthermore, a case study was discussed to demonstrate how professionals from different areas mutually support each other and work as a team. It also brought the theories associated with palliative care into practice.

IV. Provide Trainers with Resources to Prepare Teaching Materials

Besides recommending experienced palliative care speakers and teachers and besides holding courses and speeches, HFT has also made efforts to publish palliative care teaching materials. In these teaching materials, professionals in long-term palliative care focus on three main topics:

  • Palliative Care, including symptom control, comfort care, and;
  • Education, including the continuing palliative care education to different professionals;
  • Case Study, including real clinical cases to share experiences and serve as references to long-term care facilities.


Concluding Remarks

According to the Ministry of Health and Welfare, Taiwan is entering into a hyper-aged society in which the elderly consist of more than 20% of the total population, that is, every one out of five people will be an elderly person over the age of 65. As such, the elderly who stay in long-term care facilities will surely increase drastically. For them, the facilities will be like their own home as palliative care is now expanded to Eight-non-cancer patients, whether chronic diseases or critical illnesses. Hence, the development of palliative care in long-term care facilities is a crucial need in response to the change of times.

Hospice Foundation of Taiwan intends to become a major supporter of the development in palliative care for long-term care settings. Additionally, we believe the palliative care should not be standardized, but rather, the highest quality must be provided. This is why we reiterate the importance to build up a custom-made palliative care in long-term care settings based on each facility’s unique demands and conditions in order to ensure the elderly’s ideal dying well.