Elderly people dying in emergency departments

Elderly people are being taken to emergency departments in their final hours of life and dying "under fluorescent lighting in a hospital cubicle" because many aged-care homes are not equipped to provide palliative care.

It is common for ambulances to be called for people in their final stages of a terminal illness, with nursing home staff not experienced enough to recognise and treat a dying person, health professionals say.

Australasian College for Emergency Medicine president elect, Dr Simon Judkins, said people who should be receiving palliative care are sometimes dying in an emergency department cubicle before there was time or space to send them to another ward.

"We get quite upset by that because coming to hospital and passing away in an emergency department is not by anybody's definition a good death," he said.

"My concern is for the family and the patient who has to spend their last hours in a busy, noisy, overcrowded environment."

About 70 per cent of Australians would prefer to die at home, but less than 10 per cent are able to, research has estimated.

Veteran palliative care nurse Lynette Dickens recalls a case in Frankston where a woman in her 90s and living in an aged-care home was sent back to hospital a second time, for treatment of injuries she received in a severe fall.

But she said doctors had already made a decision not to give her a general anaesthetic to treat broken bones due to her fragility.

"She knew, of course that she was dying. It was really quite cruel to have this tiny lady sent off to hospital," Ms Dickens said.

"They virtually put her in one of the transitional cubicles and she died there."

Experienced doctors and nurses will often describe being able to recognise the telltale signs of dying - mottled hands and feet that turn purple, a loss of appetite, confusion, problems breathing and a sinking into unconsciousness.

In the final days, some start plucking at their blankets.

"The things that would be most distressing are agitation and delirium, or vomiting, but those can actually be managed very well with the right expertise," said Palliative Care Victoria chief executive Odette Waanders???.

"A trained professional who knows how to manage those symptoms would immediately put in place treatment.

"But you can't expect a personal care worker [who only has a certificate three or four qualification] to monitor and read whether a treatment is working or not because they don't have the assessment skills."

Most Australian nursing homes have no minimum legal ratio of staff to residents, and there is no statutory requirement to have a nurse on duty at all times.

"I think the reluctance of the aged-care industry to address the staffing requirements is a real ongoing concern," Ms Waanders said.

"There are some really great examples of residential aged-care services who are providing leadership and providing a palliative care nurse within the service, but that's not typical. That's unusual.

"I feel it's a national shame that we are not doing better for older people as we approach the end of their life."

Dr Judkins said it was also his experience that aged-care facilities had fewer experienced nurses. He said bolstering hospital outreach services for those in their last 24 hours of life could help.

Dr Lorraine Baker, Victorian president of the Australian Medical Association, said GPs also observed that rosters were often filled by casual staff or people from agencies, who were not familiar with patients.

"If that occurs it is more likely documents aren't located that have statements in them around patient's plans for their end of life," she said.

The story Elderly people dying in emergency departments first appeared on The Sydney Morning Herald.

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