Many inpatients in the palliative care unit are suffering from advanced cancer or other end stage illnesses with limited prognosis of few months. These patients are admitted for symptom control, inability to cope in the community or end of life care. As per Queensland Health rule, maximum inpatient stay should be 35 days unless patient is acutely ill. Patients who are stable but cannot return home need to be assessed for nursing home placement.
Our general observation is many patients actually deteriorate after assessment and die before they reach to a nursing home facility. There is no published literature on this subject.
We have completed feasibility study to determine if the preliminary results reflect our clinical suspicions. On the basis of these results, we feel that the study is worth pursuing and will add to the evidence base for palliative care.
We aim to extend our data range to include a three-year period., spanning from July 2015- July 2018. Currently we have one third of the data from this window recorded, and have drawn some preliminary results.
We would compile a list of patients referred for aged care assessment from our unit over a three-year period. All the charts would be reviewed and data collected on duration of admission, diagnosis, age, gender, date of referral for assessment and outcome; death, transfer to aged care facility or discharge home.
Results from feasibility study
Patients were referred for aged care assessment after median stay of 21 days in the unit. All the patients were assessed by the specialist, considered stable and appropriate for placement. All the patients were discussed in MDT meetings as well as family meetings carried out for most patients regarding discharge destination. Patients were informed and consented by the specialist for aged care assessment, in presence of family. Assessments were completed within a week after the consent.
Preliminary results indicate
Average length of stay after the assessment was 21 days.
16 patients (48%) deteriorated and died in the unit while waiting to be placed.
Two patients went back to their homes under care of family (6%).
15 patients (45%) were placed into nursing home or transitional care facility.
The realization of not able to go home and spend remaining limited life in the nursing home is quite daunting and psychologically upsetting. There is a theoretical detrimental effect on the health of patients leading to quick deterioration and death of patients with end stage diseases. This highlights a need for more hospice care or transition care facilities for palliative patients rather than to transfer them into nursing home in last few months of their lives.