1. End of Life Choices (EOLC) Programme Palliative Care Victoria Conference EOLC Nurse Management Facilitator Kevin Hardy

2. Background >Project funded by the Australian Dept of Health and Ageing and conducted by SA Health – January 2009 >Palliative care packages concept taken from SA Palliative Care Services Plan 2009 - 2016 >Packages and eligibility criteria developed. >Packages commenced in CHSA late 2009 and in Metro Adelaide May 2010

3. Four options developed >Terminal Phase Care >Stabilisation Care >Complex Continuing Care >Respite Care

4. Eligibility Criteria General >Client has a life limiting illness with an expected prognosis of three months (prognosis clinically indicated). >Client and carer agree and consent to end of life care being delivered at home. >Care can be safely delivered at home. >Provision of the package will prevent ED presentation/admission or facilitate early discharge. >Client clinically assessed as being appropriate to manage at home.

5. Eligibility Criteria General cont. >Client has access to a medical practitioner who is available and willing to accept the medical management of the client. >Packages for clients in residential aged care facilities must reflect the need for advanced clinical professional care or support care that is outside the capacity and scope of practice for that residential care facility, both in frequency and intensity on a daily basis.

6. Eligibility Criteria General cont. >Services are not expected to exceed seven days (for terminal and stabilisation options). >Where the program coordinator or service provider identifies the availability of an alternative funding stream to support client care, that funding stream is to be utilised (DVA, Private Health, Workcover). >Packages of care are designed to supplement or top up existing community supports already in place or available.

7. Terminal Phase Care - criteria >Palliative Care Phase – Terminal >AKPS 30 or < >RUG – ADL score of 15 or > >Client death is expected within the next seven days. >Client and carer/family preferred place of death discussed and agreed to as home. >Daily review required.

8. Stabilisation Care - criteria >Palliative Care Phase – Unstable/Deteriorating >AKPS – 50 or < >Acute onset/exacerbation of new or existing symptom. >Symptom management available at home. >Will require hospitalisation / continuing care at home if not resolved. >To assist transition from hospital to home. >Maximum of seven days per package. >Daily review depending on symptom.

9. Complex Continuing Care - criteria >Palliative Care Phase - Deteriorating >AKPS – 50 or < >ACAT to be discussed/considered (if appropriate). >No or limited carer support. >Needs to be known to Specialist Palliative Care Service to assist with management. >Monthly reviews required. >Maximum of three months per package. >All other eligible support options considered and utilised.

10. Respite Care >Palliative Care Phase – Stable >AKPS 60 or < >RUG – ADL score of 10 or > >Significant carer risk with carer Problem Severity Score assessed as severe. >Other respite options utilised (CCRC and Volunteer where appropriate). >Maximum of 40 hours of respite care that can be utilised over an extended period.

11. Achievements to date >CHSA commenced the roll out of packages at the end of October 2009 via the End of Life Choices program. >SA Health commenced their EOLC program in May 2010 >Over 1500 packages of care of been provided to support end of life care in the community across South Australia since the inception of the EOLC program

12. CHSA packages July 2010 – June 2013 >Total number of packages provided 702 >Number of packages by type:- >Terminal 122 >Stabilisation 112 >Complex 427 >Respite 41

13. CHSA packages July 2010 – June 2013 >Average duration per package 19 days >Average duration per package by type:- >Terminal 7 days >Stabilisation 9 days >Complex 27 days

14. CHSA packages July 2010 – June 2013 >Average cost per package $1460 >Average cost of package by type:- >Terminal $1085 >Stabilisation $ 409 >Complex $1926 >Respite $ 560

15. Case study >50 year old female diagnosed with CA Breast with cerebral metastases. Daily hygiene assistance provided along with weekly input from Palliative Care CN for symptom management. EOLC complex continuous care option assisted in keeping client out of hospital for 43 days and allowed her husband to return to part time work. >Client admitted to hospital with uncontrollable nausea / vomiting and died 5 days later. (client had indicated preference to die in hospital at start of home care). >Family reported significant benefit in having her home prior to death instead of being admitted to hospital for long terminal admission.

16. Case study >63 year old female with Pancreatic CA, liver and lung metastases. Lived with her sister who was her main carer. Client’s carer had a physical disability which restricted her mobility. As client’s condition deteriorated carer unable to provide adequate support. >Additional PMA and Nursing support provided over a period of 31 days. >Level of support increased as condition deteriorated further. >Client died at home as was her wish.

17. Summary >Both of the previous cases reflect situations that would have resulted in long hospital admissions prior to death without additional level of support provided by EOLC options. >One case provided significant benefits by keeping the family unit together at home whilst respecting client’s wish not to die at home. >The other was able to facilitate the client’s wish to die at home by supporting the primary carer as care needs increased. >Both cases reflected significant cost advantages when compared to cost of having people admitted to acute setting for long periods prior to death.