Background Residential aged care facilities (RACF) have high mortality rates, yet multifaceted challenges, including complexity of clinical needs, care fragmentation, staffing capacity and access to palliative care supports, impact on the quality of palliative and end of life care in this setting.¹ Timely palliative care engagement plays an integral role in reducing avoidable and unwanted hospital admissions, improving quality of life, and supporting preference-based care. Established in 2016, Responsive Acute Palliative Intervention and Decision Assistance (RAPID Assist) is an outreach service which aims to provide timely and responsive specialist palliative care support to bridge care gaps/transitions, address the urgent palliative care needs of RACF residents and establish timely linkage with community palliative care services (CPCS) to assist continuity of care.²

Objective To evaluate the effectiveness of RAPID Assist in providing aged care residents with palliative care in their preferred location, through analysing referral response/interventions, outcomes of service and congruence between preferred and actual place of death.

Methods A prospective cohort study of RACF residents referred to RAPID Assist between March 2021 and March 2024. Data was collected prospectively from electronic medical records and analysed descriptively.

Results Over the three-year period, RAPID Assist received and accepted 610 referrals (594 individual residents). Most residents referred were female (62.3%), and less than half (40.4%) were from culturally and linguistically diverse backgrounds. The main source of referrals was from outreach services (75.6%), with 60.8% of referrals reviewed on the same day. Service characteristics and outcomes are provided in table 1. The leading causes of deterioration upon referral were sepsis (28.2%) and dementia (17.5%). The most common referrals were for symptom control (50%) and to facilitate admissions to CPCS (27%). Five hundred and forty-one residents are known to have died following RAPID Assist review and most were able to die in their preferred location (87.8%). RAPID Assist facilitated 296 CPCS admissions, prevented 58 hospital presentations, aided 433 residents with symptom management and expedited 58 discharges from hospital over the 3-year period.

Discussion These results show that RAPID Assist provides a timely and effective intervention to bridge care transitions from hospital and in the community to address urgent palliative care needs of RACF residents. Despite the complex dynamic RACF environment, the service enables more residents to receive care and die in their location of choice. Exploring the experience and support of RACF staff and families may impart insights to enrich service delivery.

Conclusion Rapid Assist is a beneficial service that aids RACF residents in accessing timely palliative care to meet urgent needs, optimise outcomes, and ultimately supports residents to receive care and die in their preferred location.

References

1. Rawlings D, Damarell R, Chakraborty A, Devery K, Tieman J. Rapid review of the literature on end-of-life care in aged care and community settings. Sydney: ACSQHC; 2022.

2. Le Brian, Marston C, Kerley C, Eastman P. Facilitating the choice of dying at home or in residential care with the implementation of a palliative care rapid response team in a cancer centre and general hospital. EAPC. 2019;33(4).