Establishing a role for occupational therapists in end‐of‐life care in Western Australia

Abstract

The role of occupational therapy in end-of-life care in Australia has recently gained interest from the profession, consumers and other health disciplines. Factors contributing to this interest include concerns by service providers attempting to cope with an ageing population, changing patterns of disease, new models of service delivery and emerging research into the benefits of occupational therapy for people who are dying. As occupational therapy researchers committed to promoting the role of occupational therapy in end-oflife care, we commend the authors of a recent publication ‘The role of occupational therapy in end of life care’ (Burkhardt et al., 2011) published in the American Journal of Occupational Therapy. This thought-provoking article articulates ‘best practice’ occupational therapy for end-of-life care in the United States (US). However, there are many differences between Australia, the US and other countries regarding the role of occupational therapy in this practice context. The purpose of this paper is to discuss these differences with particular reference to research completed in Western Australia, but generalisable to Australia. Additionally, recommendations will be made to assist the occupational therapy discipline work towards the ‘best practice’ model discussed by Burkhardt et al. The first discussion point is the key difference in public vs. private vs. no funding for the receipt of health services, an issue which confronts US citizens. In the US, only citizens who have access to private health insurance or financial resources might benefit from ‘best practice occupational therapy’. In contrast, while all Australians have access to Commonwealth-funded health care, there is variable uptake of services at the end of life. Research completed by Rosenwax and McNamara (2006) demonstrated that access to palliative care continues to be inconsistent, with just 68% of people with cancer and 8% of people with non-cancer conditions receiving specialised palliative care. People who require end-of-life care are not always able to access services in a timely and efficient manner. Many complex variables contribute to this issue including geographical location, marital status, diagnosis (malignant vs. nonmalignant conditions) and socioeconomic status. Inconsistencies in access to care are evident for indigenous Australians, the elderly and people residing in residential aged care facilities (Palliative Care Australia, 2009). In some parts of Australia, referral to specialised palliative care services continues to be problematic. Uncertainties exist around if and when to refer, often creating unnecessary delays and crises. These uncertainties may be related to the dichotomy of active treatment vs. palliation with some relationship with the treating physicians’ speciality (oncology vs. haematology vs. other specialties) (McNamara, Rosenwax, Holman & Nightingale, 2004). Choices regarding the place of care and preferred place of death may be limited. Dedicated tertiary palliative care services, both public and private, often consist of palliative care beds spread throughout hospitals serviced by a palliative care team. The ‘hospice ethos’ is limited to several private inpatient facilities, which offer palliative care ‘wards’ with access to specialised services. Community-based, public-funded palliative care is delivered predominately in the metropolitan area and larger rural towns by a single organisation, but their services, ‘hospice at home’, are not delivered to people living in residential aged care facilities. In summary, there is evidence that many of the internationally accepted ‘standards’ for best practice in Sharon Keesing MSc (OT), BAppSc (OT); Lecturer. Lorna Rosenwax PhD, MSc, PGDip, BAppSc (OT); Professor.