National Palliative Care Week 2020 – Connecting people at home with specialist palliative care

Kevin Hardy, Nurse Practitioner | Calvary Palliative Care Home Service, Calvary North Adelaide Hospital

This year’s National Palliative Care Week theme is “Palliative Care: It’s more than you think.” What is something you tell people about palliative care that surprises them?

The most common misconception I encounter when discussing palliative care with patients is that they think it is only required when you are approaching the very end stage of their illness. They are often surprised when we explain that we regularly get involved with people that may have anything up to six months to live.

People also often suggest that we should change the name “Palliative Care” to something else because of the stigma associated with it. My response to that is that whatever it might be changed to will, in time, be associated with End of Life Care. For example if I was to change my title to the ‘Happy Nurse Practitioner’ instead of Palliative Care Nurse Practitioner, in time, people would know what the ‘Happy NP” was coming to talk to them about.

For me the stigma associated with the name Palliative Care is generally associated with our society’s reluctance to engage in any discussion to do with death and dying. It is probably a poor reflection on how the Palliative Care sector in general has struggled to address this issue. I would love to think that by the time my career in palliative care is finished that there is a much broader acceptance within society that death and dying is actually a natural part of life.

Tell us about your new and innovative work around providing specialist palliative care to clients of Calvary community care services in South Australia.

 The Calvary Palliative Home Care service is still relatively new in Adelaide but is growing steadily. The service is the first community specialist palliative care service that is funded by the majority of Private Health Insurers (PHIs) to deliver end of life care to patients in the privacy and comfort of their own homes.

Up until the commencement of the service, people in Adelaide requiring palliative care in the community would be referred to a public sector palliative care service which is a purely consultative service model. When people require hands on care such as assistance with activities of daily living, etc., the public palliative care service would then refer them to one of a number of community nursing services within metropolitan Adelaide who would provide that care.

What sets our model apart from the public sector is that our service is fully integrated within the Calvary North Adelaide Hospital. Our community nurses provide all the care required right through from admission to death at home if that is the patient’s choice.

This enables great benefits in regards to continuity of care from the one organisation. Another strength of our model is the ability to have patients move between the acute setting, Mary Potter Hospice (MPH), and the community depending on patient’s choice and care needs. Patients appreciate this aspect in particular as they see familiar faces from both MPH and the community throughout the duration of their care.

Palliative and End of Life Care is known for being able to adapt to challenge with creativity and compassion. Can you reflect on an instance where you had to adapt the way you provide care during the COVID-19 pandemic?

We recently were involved with a patient who had been receiving palliative care support at home from our service for many months. As his condition was deteriorating he required a number of admissions to the MPH for various reasons. After his most recent admission he had come to the decision that he was going to remain in the hospice for the terminal phase of his illness that was fast approaching.

The COVID-19 pandemic that unfolded in March meant that visitor restrictions were put in place within the hospice for the safety of patients and staff. This gentleman was a very well-known Adelaide identity who had a large number of friends that were wanting to visit to say their goodbyes. The patient was also keen for this to happen, so after a discussion with the hospice doctors and our community team he decided to be discharged home for his End of Life Care.

This man lived with his partner in a small apartment above his iconic Adelaide business on a busy city street. Our community nursing team arranged a hospital bed to be delivered and installed upstairs in the front room of his apartment that pretty much overlooked the street. Our service visited daily to manage all of his care needs including his medication management.

He loved being able to spend his last days in his much loved home, and was able to hear of the familiar noises of the busy city street. It also facilitated a time whereby many friends were able to visit him to enjoy a glass of wine while listening to a lot of his favourite music.

Our service provided his carers with daily face-to-face support along with the back-up of our 24 hour telephone advice support line.

What is something you have learned about the people receiving care, their loved ones, your colleagues or yourself, when thinking about how palliative and end of life care is provided during the COVID-19 pandemic?

What I learned very much confirmed what a have experienced throughout the whole of my palliative care nursing career.

That is that people facing the end stage of their life are courageous, resilient and brave.

It confirmed that carers that choose to support their loved ones at home during this time are loving and selfless, putting the needs of others before themselves.

It confirmed that my colleagues are innovative, strong, selfless and resilient. To put the needs of some of the community’s most vulnerable people ahead of the real risk to your own health is something special.

What’s next for your work; what are you looking forward to?

 I am looking forward to continuing to grow this service into one that will be able to service the broader metropolitan region of Adelaide.

We currently have a defined catchment area that was established by both the PHIs and Calvary that had to consider our current available resources. I strongly believe that if we continue to achieve excellent patient outcomes and meet the KPIs set by the funders, we will be able to expand the service more broadly.

We have also applied for a SA Health grant that aims to improve end of life care in South Australia’s residential aged care facilities. We are hopeful that, if successful, we will be able to establish Palliative Care Needs Rounds in two SA Calvary residential aged care facilities, similar to the model that has been successfully implemented by Calvary Public Hospital Bruce in the ACT.