Most people moving into long-term care are living with serious, progressive conditions. A palliative approach supports residents and families from the very beginning, focusing on comfort, dignity, and quality of life throughout their journey. Learn how LTC teams can integrate palliative principles into everyday care.

A palliative approach in LTC includes:

• Integrating a palliative approach into care from the time a person moves into LTC.
• Using knowledge of life-limiting conditions to anticipate and prepare for change.
• Reviewing goals of care regularly – from admission through to care in final days.
• Preparing residents and their families for health condition progression.
• Managing symptoms to reduce suffering and improve overall quality of life.

A palliative approach starts on move-in day.

Shift your care to a palliative approach (4:29)

Care Planning for Today and the Changes to Come

In LTC, declining health is expected. Proactive care planning helps prepare residents and families for changes, ensuring care refects their values and preferences.

Planning ahead helps avoid crisis decisions.

Three common disease trajectories (3:43)

Della Roberts, Palliative Care CNS, discusses preparing for changes to come (0:49)

Dr Trevor Janz on including conversations about future care and expectations in the annual care conference. (2:38)

Take a moment to reflect:

How can I support residents to live well today while planning ahead?

Resources

• Clinical Frailty Scale (Geriatric Medicine Research, Dalhousie University)
• Supportive and Palliative Indicators Tool (NHS Scotland, University of St. Andrews)
• When your loved one has dementia: Roadmap for families (Kooteney Boundary Division of Family Practice, Interior Health, Dr. Trevor Janz)

Goals of Care Conversations

Conversations with residents and families about what matters most to them help guide decision-making in care.

Use everyday conversations with residents and families to learn what matters most to them.

Take a moment to reflect:

What are the times when a resident would benefit from a goals of care conversation?

Framing goals of care conversations as tender exchanges can open space for compassion and curiosity  (3:13)

Resources

• You’ve been asked to be a substitute decision maker, now what? (BCCPC)
• Ask-Offer-Ask Framework (IHI Open School)
• Conversation Guide for Health Care Aides (Island Health) and
• NEW! Videos demonstrating how to use the guide when changes happen (Island Health, BCCPC with thanks to SPA-LTC):
  • Changes in function
  • Changes in eating
  • Changes when approaching death
• What Matters Most To Me worksheet (Vancouver Coastal Health)
• Discussing goals of care with your residents and families (Vancouver Coastal Health in PHSA Learning Hub)
• Culturally Safe ACP (BCCPC)

Comfort and Symptom Management

Addressing comfort by recognizing and relieving symptoms early is a key aspect of a palliative approach to care

Put comfort into every care decision.

Take a moment to reflect:

How do I recognize and respond to symptoms early?

Foundational approach to symptom management (2:58)

Resources

• Final weeks and days: What to expect (Canadian Virtual Hospice)
• PAINAD scale for those with cognitive impairment (Interior Health)
• Symptom management guidelines (BCCPC)
• Symptom Management Guide for Health Care Assistants (BCCPC)

Education

• Strengthen Your Core module Domain 4: Comfort and Quality of Life (BCCPC)
• “Managing Pain and Distress in Long-term Care” 25-minute module (Ontario Centre for Learning Research and Innovation in LTC)

Grief and Bereavement

LTC teams support residents to die with comfort and dignity, and their families to live well with this memory. Your compassionate support during their dying time and beyond makes all the difference.

LTC teams can be a bridge connecting families as well as Resident and Family Councils with community grief and bereavement supports.

Community-based Grief & Bereavement support for families:

• Hospice Societies offer a range of services including 1:1 grief support, support groups, and anticipatory grief resources.
• BC Bereavement Helpline (BCBH) – free and confidential service, with trained volunteers providing emotional support. Can refer people to grief and bereavement services near them.
• S.U.C.C.E.S.S – access grief support in languages other than English.
• KUU-US Crisis Line – access grief support for Indigenous people
• About Grief.ca – national website about grief

Take a moment to reflect:

How can I support the resident and their family in the last days and into bereavement?

Self-care for LTC Clinicians

• Healthcare Provider Grief + Self-Care (3:39) (Canadian Virtual Hospice)
• Taking Care of Me (Care for Caregivers)
• Wing Kei Care Centre module, “Restorative Practice” from the LTC palliative toolkit about self-care, reflection, and team debriefing.

Education

• Strengthen Your Core! Domain 6: Loss, Grief and Bereavement (BCCPC)
• Ontario CLRI online module, “Coping with Grief”, about grief, individual bereavement needs, and responding to grief and loss.
• Strengthening bereavement care in LTC settings (SPA-LTC)