Evidence of working together Hospital, Hospice and Aged Residential Care Te Arai Palliative Care and End of Life Care Research Group Mahi tatou - Working Together, 3 November 2017

Research Project Outline Accessing palliative care services in the ADHB in the last year of life: local, regional and national data Lead researcher Jackie Robinson, with Heather McLeod. Study period 1 January 2015 to 31 December 2015. 4,869 people who had received care from at least one Auckland DHB service in the last year of life (LYOL). Linkage of data using NHI number: hospice, hospital palliative care, DHB data, interRAI assessments (for home care and long-term care) and aged residential care data. Who provided care and did someone know the person was nearing the end of life, so that support to the person and whānau could be provided.

ADHB and non-ADHB Overall, 47% of patients were ADHB patients and they have a much older age profile than non-ADHB patients.

Confirmed Cancer A Confirmed Cancer flag was received for 22% of the patients. The highest proportions were in the ages 35-69.

Any Palliative Care Alert Overall, 39% of patients had any alert; 68% with confirmed cancer but only 31% without cancer. Current system of alerts is best at capturing people in middle adult years – the “cancer years”. Not good at identifying older people in last year of life.

interRAI Assessments Implemented in New Zealand: Contact Assessment (CA) Community Health Assessment (CHA) Home Care Assessment (HC) Long Term Care Facilities Assessment (LTCF) – mandatory since June 2015 In 2017, the Palliative Care (PC) assessment was approved for implementation in New Zealand. To be used initially by interRAI Home Care assessors with community clients. Important that this is extended as soon as possible to aged residential care settings.

Any interRAI Assessment interRAI assessment data for 46% of people in the study. Very strong shape by age. Proportionately, more interRAI assessments are done at the older ages.

Timing of interRAI Assessments Distinctly higher numbers of assessments in 90 days before death. Suggests an opportunity to ensure palliative care is provided.

ADHB ARC Place of Care 87% of the people who were in ARC and died in 2015, had only one place of care in ARC. The others had multiple places of care. In total, only 19% had some stay in rest home care while 84% had some stay in hospital-level care.

Time in Aged Residential Care Median time spent in ARC was 415 days (1.1 years). The longest stay was 5,064 days (13.9 years). Only 8.5% of those using hospital-level care had a full year of care at that level in the last year of life. Of the 1,214 ARC deaths, two died on the day of admission and 65 died in the first week of hospital-level care. 25% of the people who used hospital level-care had a hospital-level stay of 38 days or less. Length of stay in ARC is thus relatively short for many, despite some very long overall stays for a few people.

ARC in Last Years of Life 47% of all people who died in the ADHB during 2015 spent time in aged residential care. 10% of people had care only from aged residential care, with no other contact with ADHB services in the LYOL.

ARC in the Last Years of Life 47.4% of all people who died in the ADHB during 2015 spent time in ARC. There is a very strong pattern by age.

ARC and Hospital Place of Death 5.4% of all people who died in the ADHB during 2015 were in ARC in the LYOL but died in a public hospital. This group is 19.4% of all deaths in public hospital and 11.4% of the deaths in ARC.

ARC and Hospice in LYOL 11% of those who died were hospice patients and also in ARC in the LYOL. May be collaboration between ARC and hospice, or sequential use. 33% were not hospice patients and were not in aged residential care.

ARC and Hospice in LYOL 11% of those who died were hospice patients and also in ARC in the LYOL. May be collaboration between ARC and hospice, or sequential use. 33% were not hospice patients and were not in aged residential care.

ARC and Hospice in LYOL Only 19% of those with cancer were not hospice patients and not in aged residential care during the last year of life, compared to 36% of those with other conditions.

Evidence of Working Together First evidence of place of care, not only place of death. Linked data to begin to see the trajectories in the last years of life. Important information on gaps for Palliative Care Governance Group: Hospices and Hospital Palliative Care team Aged residential care Primary care DHB planning and funding This has served as a pilot for a larger national study now underway. Caution: this is only one DHB and some incomplete data. We also need to remove the sudden deaths that are not amenable to palliative care.

Jackie Robinson BHSc, MPallCare Nurse Practitioner, Auckland City Hospital Palliative Care Service Professional Teaching Fellow and PhD Candidate, School of Nursing, University of Auckland Phone: 09-3074949 extn 23918 Mobile: 021 938 020 Fax: 09-3754380

Heather McLeod & Associates Ltd Body, Mind, Soul Earth Heather McLeod Heather McLeod & Associates Ltd Honorary Senior Research Fellow, School of Nursing, University of Auckland Extraordinary Professor, Department of Statistics and Actuarial Science, University of Stellenbosch heather@heathermcleodnz.com www.heathermcleodnz.com