Discharge to aged care facility for palliation

A practical guide for discharging a patient to their residential aged care facility for palliation.

Key actions to consider

• Have informed discussions with the:
  • patient if possible
  • substitute decision makers, e.g. guardian, family, carer
  • GP
  • nursing home staff.
• Ensure there is a registered nurse at the facility who can give PRN S8 medications.
• Ensure the patient is sent home with at least 2-3 days supply of medications, particularly if over the weekend, where the facility may have difficulties getting pharmacy access to S8 drugs.
• Write up a drug chart with all the prescribed palliative care medications. Send it with the patient to ensure the nursing home staff can administer medications until the GP transcribes them to the facilities medication chart.
• Arrange community palliative care support where available or confirm if the GP will coordinate this. Familiarise yourself with available local services.

Notes on community and GP roles

• Some GPs will be happy to manage these patients in the community alone.
• Some residential aged care facilities will have a palliative care clinical nurse consultant who covers their patients.
• Community palliative care is available in some areas via the local hospice or hospital palliative care teams

Resources

• Last days of life
  Toolkit to improve and support the care of the dying patient, including symptom management flowcharts, and medication management guides.
  Source: Clinical Excellence Commission
• End of life and palliative care: Blueprint for improvement
  The NSW framework, guidelines, principles and components to meet the needs of people approaching and reaching the end of life, their families and carers.
  Source: Agency for Clinical Innovation
• End-of-life planning
  Information for patients to consider when planning their end-of-life care.
  Source: Alzheimer’s Association 
• Health professionals
  Plan and coordinate palliative care for people living in the community.
  Source: CareSearch

Acknowledgements

Written by Dr Nadia Bowman, 2017. Reviewed by Dr Guru Nagaraj, 2020 as part of the Australasian College for Emergency Medicine Geriatric Special Skills Term at Hornsby Hospital.

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