Resuscitation (or “resus”) in aged care is a complex and sensitive topic. It sits at the intersection of medical ethics, patient rights, and the responsibilities of healthcare providers.
With an aging population and increasing demands on the aged care system, ensuring the wishes of residents and their families are met is highly important. Conversations regarding the level of medical interventions or end-of-life care are difficult to start. However, it is important to remember that future planning ensures individuals’ values, beliefs and health goals are maintained.
The Context of Aged Care in Australia
Australia’s population is aging rapidly, with 13% now over 65[1]. As the need for aged care services continues to grow, so does the complexity of providing care to residents with various health conditions. While aged care facilities are focused on providing quality of life and dignity, they are frequently faced with medical emergencies, some of which may call for resuscitation.
Resuscitation, particularly cardiopulmonary resuscitation (CPR), can be lifesaving, but in aged care, the decision to administer it is not straightforward. Many residents have multiple comorbidities, reduced mobility, and often a limited life expectancy. For some, interventions like CPR can be considered aggressive as it can result in broken or fractured ribs. Therefore, making an informed decision regarding ongoing care and emergency interventions is paramount.
Ethical Considerations
One of the most significant challenges in resuscitation within aged care is balancing ethical obligations. Healthcare providers must respect residents’ autonomy and wishes while also considering what is medically appropriate.
- Autonomy and Advanced Care Planning: Residents have the right to make decisions about their care, including whether they wish to receive resuscitation in the event of a medical emergency. Advance care directives (ACDs) are legal documents that allow individuals to outline their preferences for treatment, including resuscitation. A well-documented ACD can guide healthcare providers and ensure the care delivered aligns with the resident’s wishes. It is best practice to ensure there is clear legal documentation for each resident regarding their wishes for medical intervention.
- Beneficence and Non-Maleficence: Healthcare providers are bound by beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm). In some cases, resuscitation may cause more harm than good, especially in elderly patients with a low likelihood of recovery. This raises questions about the appropriateness of resuscitation efforts in certain scenarios.
- Family Involvement: Families often play a crucial role in decision-making, especially when residents can no longer communicate their preferences. Healthcare providers must navigate the delicate dynamics of family wishes, which may sometimes conflict with the resident’s previously expressed desires or what is medically advisable.
Legal Framework
In Australia, state and territory laws govern the legal framework surrounding resuscitation in aged care. These laws dictate how advance care directives are recognised and enforced. Additionally, aged care facilities must adhere to the Aged Care Quality Standards, which emphasise person-centred care and respect for residents’ rights and choices.
Importantly, aged care providers must ensure that all staff are trained in understanding and respecting advance care directives. This includes knowing when not to perform resuscitation, which can sometimes be more challenging than initiating it.
The Role of Healthcare Providers
Healthcare providers in aged care facilities play a critical role in discussing and documenting resuscitation preferences with residents and their families. This should ideally be part of a broader conversation about advance care planning and should start when the resident first enters care.
Staff must be trained in the technical aspects of resuscitation as well as communication skills. These conversations can be difficult and require sensitivity, as they touch on mortality, dignity, and the resident’s quality of life.
Challenges and Considerations
Despite the best intentions, implementing resuscitation policies in aged care is not without its challenges:
- Diverse Resident Preferences: Not all residents have clear preferences regarding resuscitation, and some may not have documented their wishes at all. In these cases, healthcare providers may need to make rapid emergency decisions, often with limited information.
- Resource Constraints: Aged care facilities often face resource constraints, including staff availability and access to medical equipment. These limitations can impact the ability to perform resuscitation effectively or safely.
- Emotional Toll on Staff: Performing or withholding resuscitation can significantly impact aged care staff. Regular training and debriefing sessions are essential to support healthcare workers’ mental health and well-being in these settings.
Moving Forward: Best Practices
- Proactive Advance Care Planning: Encourage residents to document their preferences early and ensure these directives are easily accessible to all relevant staff.
- Regular Staff Training: Provide ongoing staff training in resuscitation techniques, communication, and ethical decision-making.
- Family Engagement: Involve families in care planning discussions to ensure that everyone’s on the same page and to reduce the likelihood of conflict during emergencies.
- Holistic Care Approach: Prioritise a holistic approach to care that balances medical interventions with quality of life considerations. This might include palliative care options that align with the resident’s goals.
Conclusion
Resuscitation in Australian aged care requires careful consideration of ethical, legal, and practical factors. By focusing on advance care planning, respecting resident autonomy, and supporting staff, aged care facilities can make resuscitation decisions thoughtfully and compassionately. Ultimately, the goal is to honour the dignity and wishes of each resident, providing them with the best possible care at the end of life.
Reference:
1 Australian Beau of Statistic, 2024, https://abs.gov.au/census/find-census-data/quickstats/2006/POA2024