Private Palliative Care for Older Persons was started by DPH on 1st of March 2010. This is an extra paid for home-care service for persons needing daily care beyond the free palliative care service provided to patients with a life-threatening illness in line with the current DPH admission criteria. (see Palliative Care)

It has been found that older people suffer unnecessarily because of widespread under-assessment and under-treatment of their problems. The real needs of older people – pain relief, to feel involved and listened to and to enjoy a certain degree of autonomy - are often not met. Common symptoms experienced by Older People are mental confusion, urinary incontinence, pain, low mood, constipation, dizziness, sight & hearing difficulties and loss of appetite.

Traditionally, high quality care at the end of life has mainly been provided to cancer patients, but this kind of care needs to be provided to those with a wider range of diseases. Older persons are more likely to have complex problems and disabilities, and need packages of care that require partnerships and collaboration between different groups and across many settings.

Why Palliative Care?
Older people are more commonly affected by multiple medical problems of varying severity
The cumulative effect of these may be much greater than any individual disease, and typically lead to greater impairment and needs of care
Older people are at greater risk of adverse drug reactions and of iatrogenic illness (illness caused by medication)
Minor problems may have a greater cumulative psychological impact on older people
Problems of acute illness may be superimposed on physical or mental impairment, economic hardship and social isolations

The palliative care measures need to therefore include adequate pain and symptom relief, good communication and information, and coordinated care from teams of skilled professionals who help meet preferences and requirements of care.
Davies, E & Higginson, IJ (eds); Better Palliative Care for Older People. Published by The World Health Organisation (Europe) 2004.

Why a paid for service?
This service is an extra, over and above, the free service delivery for life-threatening illnesses.
Many older persons would like to stay in their own homes, be independent, have their symptoms managed and personal needs seen to by a professionally trained and supervised team.
Many family members would appreciate the knowledge that their elderly parents are visited daily, have good food to eat, know that their personal hygiene is maintained and that they continue to enjoy quality of life.
DPH has the expertise and trained staff. The income from this service will ensure the sustainability of the free palliative care service.

What service is offered?
The specifics of the service will be negotiated with each client according to their needs and the team includes the patient’s own doctor and specialist.
The service may include:

1. Physical care:
   Medical: Active symptom & medication management by a Professional Nurse who is supervised by and consults with a medical doctor. The Professional nurse negotiates the care plan with the client and in turn supervises the HBC worker.
   Physical: Personal hygiene, comfort, pressure care, bathing, dressing, wound dressing, exercise
   Light household tasks: Cooking, feeding, making the bed, washing dishes/laundry as time allows etc.
2. Social Support:
   Groups, volunteer visits, listening & communication, outings, assisting with daily living tasks and social worker consultation if required.
3. Emotional Support:
   Information, companionship, volunteers visits and social work consultation if required.
4. Spiritual Issues:
   Hospice is a non-religious organisation and are respectful of the patients views on religion and other ethical issues e.g. around use of antibiotics and feeding tubes. We aim to improve or maintain quality of life based on the patients view of quality (patient-centred care).

Private Palliative Care for Older Persons is provided by an interdisciplinary team:

1. Home Based Carers will do the day to day caring under the supervision of a Professional Nurse.
2. A Professional Nurse will do the initial admission and assessment and then devise the care plan and visit the patient bi-monthly.
3. A Doctor (own or other) will consult with the Nursing Sister or visit the patient (on request) once a month.
4. The patient’s private doctor will remain part of the treatment team.
5. A social worker is available if required.
6. Referrals to other complimentary organisations will be made on request.