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Allied Health Team

Allied Health Professionals (AHPs) are described as 'University qualified practitioners. They specialise in preventing, diagnosing and treating a range of conditions and illnesses.'

Each of these professions have regulatory bodies that ensure clinicians are adequately trained to work within their scope. AHPs are required to undertake professional development in a variety of areas relevant to their work to maintain currency. More education and teaching resources are available from PaCE Aged Care, an online directory of palliative care education options suitable for aged care.

The list of Allied Health Professions, as described by the Allied Health Professions Australia (AHPA) is broad. The Department of Health and Aged Care (DoHAC) particularly reference those that attract Medicare funded services.

These larger allied health groups are:

The Accredited Practising Dietitian’s (APD) role is working with the older person and their family/carers to create realistic goals and expectations for diet and oral intake. As well as ongoing assessment for:

  • changes in dietary intake, weight, and swallowing (in close consultation with the speech pathologist)
  • quality of life in relation to eating and drinking
  • need for nutritional supplements
  • level of independence with shopping and cooking.

A dietitian might also:

  • Support the multidisciplinary team with the nutritional management of symptom-related problems such as loss of appetite, altered taste and smell, dysphagia or cachexia.
  • Facilitate discussions on the potential benefits and burdens of supplemented oral, enteral, and parenteral nutrition.
  • Advise on preparation, fortification, supplementation, and relaxation of previous dietary restrictions as appropriate for the individual and their needs.
  • Work closely with a speech pathologist to maximise eating and drinking options where a swallow deficit has been assessed.

The NSW Agency for Clinical Innovation has the following video, Nutrition and palliative care that describes the role of nutrition in palliative and end of life care.

The Occupational Therapist (OT) liaises within the interprofessional care team to promote best outcomes. OT’s who work with older people receiving palliative care at the end of life may contribute in numerous ways during end of life:

  • Assessment for people approaching the end of life is often observational and functional.
  • Standardised screening tools may be used in some settings to measure symptoms such as (some of these can be found in the ELDAC Clinical Tools page):
    • Fatigue (Brief Fatigue Inventory)
    • Breathlessness (Modified Borg Breathlessness Scale)
    • Falls risk assessments and pressure risk screens may also be conducted (e.g., Norton Pressure Sore Risk Assessment Scale or the Braden Scale).
  • Standardised cognitve assessments used by occupational therapists may include the
    • Montreal Cognitive Assessment (MOCA)
    • the Rowland Universal Dementia Assessment Scale (RUDAS), or
    • the MMSE (Mini Mental State Examination).

However, it is important to note that standardised assessments around goal setting must be used with care as not all people approaching the end of life relate to goal oriented language and may find it confronting. ‘Priorities’ is an alternative term that may be more meaningful.

  • Assisting with non-pharmacological management of symptoms e.g. education, counselling, relaxation techniques, task redesign and skilled equipment prescription.
  • Providing support to the person to remain in/return to the place of care of their choice through assessment, intervention and care co-ordination.

Occupational Therapy Australia co-produced this Occupational Therapy in Palliative Care video explaining the role of an OT in Palliative Care.

Physiotherapists may contribute in numerous ways during end of life:
  • Assess therapy needs and appropriate therapeutic interventions. Physiotherapists may use a range of methods to record the assessment outcomes and progress, including:
    • WHO-5 personal well-being
    • performance-specific tests may or may not be appropriate depending on the older person’s requirements.
  • Reassess the older persons’ changing care needs as their condition changes.
    • Measures used to assess performance and quality of life and well-being can be repeated at various time points to evaluate the older person’s progress and needs.

The results of physiotherapy assessment and tests will guide methods of physiotherapy treatment.

  • For people who are weight-bearing and mobile: they may need assessment, advice and/or intervention to improve mobility, promote independence or aid comfortable effort and reduce activity-related fatigue.
  • People who are largely confined to bed or a chair: they may need assessment, advice and/or intervention to promote relaxation, safe bed mobility and comfortable positioning, and safe transfers from bed to chair and return, and avoidance or treatment of pressure injuries. Integration of physical or electrotherapy will also assist with quality of life.

The Australian Physiotherapy Association (APA) has developed an information page for consumers on the role of physiotherapists in palliative care, and the type of support that can be provided.

Psychologists are led by the older person’s symptoms and their sense of what is important to them. They co-create realistic goals and expectations with the person in the face of impending death.

A Psychologist would initially assess or screen a person for distress, inability to cope, or anxiety or depression using a tool like the SPICT or Cornell Scale for Depression. More information on assessment tools can be found at Assess Palliative Care Needs.

Further services a psychologist might provide:

  • helping an individual understand the interrelationship between physical symptom distress and psychological distress
  • listening and counselling and allows a person to talk about any fears, worries or conflicting emotions
  • clarify misunderstandings or mis-expectations around an individual’s diagnosis and palliative care
  • helping a person identify and talk about loss or grief and may provide bereavement care and support to family and carers
  • helping a person with existential concerns such as the search for meaning in life, hope, sense of purpose, dignity, grief, and spirituality
  • assisting a person and their family to communicate and to explore relationship or emotional issues • Helping to mobilise individual or family resources, to reduce feelings of isolation and loneliness
  • acknowledging strength and achievements in the life of the person
  • introducing meditation or relaxation exercises to help ease physical and emotional pain
  • contributing to the preparation of legacies and eulogies either with the person and/or the family.

The American Psychological Association (APA) has developed a fact sheet Older Adults and Palliative and End-of-Life Care Factsheet (153kb pdf) that discusses psychological issues that can arise with life limiting illness, and suggestions for how carers and family can respond.

Speech Pathologists who work with older people receiving palliative care at the end of life may contribute to care planning via:

  • assessment of communication
  • cognition and swallowing function to determine relevant management strategies and therapy needs / interventions.

The results of communication and swallow assessment will guide methods of treatment and care, such as:

  • optimising the older individual’s ability to eat and drink in the safest, most comfortable way and to participate in mealtimes.
  • educating the individual, their carers and family on safe swallowing technique
  • educating and collaborating with the individual and their family to support their ability to make informed choices and ensure a documented care plan when eating / drinking with acknowledged risk and advising on risk and benefits of feeding modes in cases of dysphagia (? see Hot Topics)
  • may work with a pharmacist to provide assessment information to inform medication administration routes
  • helping to optimise the older individual’s ability to communicate, particularly to support their ability to participate in end of life decision making, communicate choices, needs and emotional states and maintain social and emotional closeness and relationships with family and friends
  • providing education and advice to communication partners (family, carers, health team etc) with regards to communication, cognition and swallowing function, and how to best support communication as a communication partner
  • cognitive stimulation to improve or maintain communication function in people living with moderate to severe dementia
  • assessing and supporting strategies to manage oral care and hygiene including excessive saliva production (drooling) and dry mouth (teaching the family on how to assist with this).

The NSW Agency for Clinical Innovation has the following video on speech pathology and palliative care.

Social workers view the person holistically and hence acknowledge that the identity of the person and their behaviours and wishes, needs and preferences cannot be seen in isolation. Where indicated, a social worker might complete a full psychosocial assessment which would inform subsequent care plans, as well as:

  • counselling that supports cultural, emotional and psychological needs for the individual at end of life
  • help for friends, families and partners so that they can be involved in care and decision-making, as appropriate
  • linking in the person, family or carers with financial and legal support services to assist with management of financial or legal issues, if needed and any other community resources e.g. support groups
  • help the person to identify others who are important to them and highlight and explore relationship issues.
  • empower the person and those close to them to work towards completion of any unfinished business
  • may advocate for the person’s wishes to the palliative care or healthcare team liaises within the care team to promote best outcomes
  • provide grief counselling of pre-bereaved or bereaved family members including those experiencing complex bereavement
  • assist with accommodation or placement such as residential aged care, respite care and supported accommodation
  • assist with Advance Care Planning.

Palliative Care Social Work Australia (PCSWA) has a number of useful resources with topical content including video vignettes of quality care provided by social workers.

Various Commonwealth-funded activities available to ensure a Pharmacist can review people in their home environment.

MedsCheck

  • The MedsCheck service involves an in-Pharmacy one-on-one discussion and medication review provided by a pharmacist.
  • These services address concerns or questions a person has about their medicines.
  • Importantly, anyone can arrange a MedsCheck if concerned about the person's medications, including themselves.

Home Medication Review (HMR)

  • The HMR Program intends to support the quality use of medicines and assist in minimising adverse medicine events by helping people to better understand and manage their medications.
  • The HMR must be requested by the person's usual GP and accredited pharmacists must perform the review.
  • There are provisions for other medical officers to initiate an HMR (e.g. hospital doctor), which is particularly useful when the hospital admission results in significant changes to the person's medications.

Alternatively, in residential aged care funding exists for clinical reviews as:

Residential Medication management review (RMMR).

  • The RMMR Program intends to support the quality use of medicines and assist in minimising adverse medicine events for people living in approved Australian Government-funded Aged Care Facilities.
  • The RMMR must be requested by the person's usual GP and conducted by accredited pharmacists.
  • There are provisions for other medical officers to initiate an RMMR (e.g. hospital doctor), which is particularly useful when the hospital admission results in significant changes to the person's medications.

Quality use of Medicines

  • Supports the delivery of services and activities by pharmacists to support the quality use of medicines within Australian Government-funded Aged Care Facilities.

Since 1 July 2024, funding has been available for community pharmacies and aged care providers to employ on-site pharmacists in residential aged care homes. The Aged Care on site pharmacist guide for residential aged care provides more detail on eligibility and scope of role.

Residential aged care homes that take up an on-site pharmacist will not be able to receive Quality Use of Medicines (QUM) and Residential Medication Management Review (RMMR) Program services from visiting pharmacists at the same time.

Allied Health professionals work predominantly with older people and their family and carers across all aged care settings. In addition, AHP’s can provide education to aged care providers and care staff, family and carers on a range of topics to enhance care for the older person at end of life.