Standard 3 - Requirement (3) (c)
The needs, goals and preferences of consumers nearing the end of life are recognised and addressed, their comfort maximised and their dignity preserved.
Intent of this requirement
This requirement focuses on how personal and clinical care is delivered at the end of a consumer’s life. Organisations are expected to recognise the needs, goals and preferences of consumers who are nearing the end of their life. Communication with the consumer and a care and services plan that reflects to their needs, goals and preferences will support this requirement.
An understanding that dying and death are part of each consumer’s human experience, not just a biological or medical event, needs to underpin all end of life care. Organisations that take the right approach will deliver care that is culturally safe, provide it in the most suitable setting, and deliver it in a timely manner.
To maximise the consumer’s comfort and maintain their dignity at end of life organisations need access to an appropriately skilled and qualified workforce. There needs to be a timely response if a consumer is in physical, psychosocial or spiritual distress to ensure suffering is prevented or relieved and their dignity is maintained at their end of life. How an organisation does this will depend the setting, the needs of consumers and what specialist resources and members of the workforce they have available. It will also need to be in line with relevant national practice guidelines and state and territory programs.
Involving a consumer’s representative in their end of life care decisions must be in line with a consumer’s wishes. Where a consumer lacks the capacity to make decisions they may have a court or tribunal-appointed guardian to make decisions on their behalf. When this is the case an organisation needs to manage this according to relevant law and best practice guidance.
- How are the consumer’s needs, goals and preferences for their end of life care reflected in their care and services plan, including the situation, environment and place where they wish to die?
- What processes are in place to support conversations with the consumer, and others the consumer wants involved, about their cultural, spiritual and physical needs?
- How does the organisation make sure that they promptly recognise when the consumer is moving to the terminal phase of life? And how do they communicate this to the consumer, others the consumer wants involved and relevant health professionals?
- How does the organisation work with others outside the service (such as palliative care specialists) to improve the consumer’s end of life care?
- How does the organisation evaluate and review end of life services to make sure they are effective and meet the needs and preferences of consumers?
Examples of actions and evidence
- Consumers say they feel confident that when they need end of life care, the organisation will support them:
- to be as free from pain as possible
- to have those important to them with them
- to die in line with their social, cultural and religious and spiritual preferences.
- Consumer representatives say they feel positive about their experience with the organisation and the workforce at the time of the consumer’s death.
Workforce and others
- Relevant members of the workforce say they feel well prepared and supported to have conversations with consumers about end of life care.
- Relevant members of the workforce can describe how they support consumers at the end of their lives. This includes being as free from pain as possible, having those important to them with them, and dying in line with their social, cultural and religious and spiritual preferences.
- Evidence that the workforce, through their education and experience, recognise end of life signs and can review a consumer’s needs, goals and preferences in line with their wishes.
- Members of the workforce are respectful and can describe how they have supported a range of consumers to make end of life choices. This includes situations where the consumer’s wishes have been different to what the workforce member or organisation believes.
- The workforce can describe how they support consumers to direct their own end of life care where possible.
- Workforce orientation, training or other records that show how the organisation supported the workforce to meet this requirement.
- Care and services plans reflect changes in care and services, in line with the consumer’s end of life care needs, goals and preferences. This includes advance care planning when this has occurred.
- Examples of the use of tools and resources for supported decision-making with consumers, representatives and others they want to involve in decisions about their end of life care.
- Policies and procedures for end of life care document how to recognise when consumers are at the end of life and what supervision and support is provided to members of the workforce providing end of life care.
- Examples of activities the organisation has implemented to balance end of life care with consumer goals and best practice and how these activities have been evaluated.
- Evidence of how the organisation monitors and reports its performance against this requirement.