SPA-LTC Model

The Strengthening a Palliative Approach in Long-Term Care Palliative Care Model 

SPALTCModel

The Strengthening a Palliative Approach in Long-Term Care Palliative Care Model includes four Phases: (a) Before Entering LTC, (b) After Moving in to LTC, (c) Progressing into Advanced Illness/End of Life, (d) and Grief and Bereavement. It has been developed based on a synthesis of the literature and feedback from key stakeholders, including LTC staff. The core programmatic features include:  information and resources for residents and family to support a palliative approach philosophy to care; mechanisms to help staff identify and activate a change in care planning based on key transition points; formalized opportunities for communication between staff, residents and families; team-building strategies, champions teams and collaborative learning opportunities within LTC; and leveraging supports and resources external to the LTC sector. 

Key Activities of Each Phase of the SPA-LTC Model

Phase

Activities

1. Pre-LTC

  • Assess resident needs within a holistic model with attention to existing chronic diseases, frailty
  • Ensure adequate support is provided if on waiting list for LTC; avoid crisis admissions
  • Allow for fluid movement into LTC and back out if resident condition warrants it

2. After Relocating to LTC


  • Support resident and family during adjustment to living in LTC; address ‘losses’ of resident and family
  • Complete full assessment upon admission, including medication review and level of frailty; ongoing as deemed necessary
  • Introduce concept of a palliative approach to residents and family & prepare them for expected changes in health conditions
  • Begin proactive discussion with resident and family about wishes and values/advance care planning with preferred tools
  • Discuss CPR options and develop plan of care at 6-week conference

Significant Resident Decline/Advanced Chronic Illness Triggered By One or More of the Following:

  • 2 or more indicators checked on SPICT (Supportive Palliative Care Indicators Tool)
  • PPS (Palliative Performance Scale) score <30%
  • J5 checked on RAI MDS
  • ‘No’ to the question: “Would you be surprised if the resident died within 6 months?”

3. Advanced 
Illness/End of Life


  • Support the resident and family through life review, emerging issues, and final separation
  • Revisit wishes and values/advance care planning discussions, including preference of place of care; hold Palliative Family Care Conference, identify goals of care & obtain informed consent (see forms); ensure resident/family’s questions are addressed
  • Review medications in consultation with the physician, pharmacist and nurse; continue only those deemed necessary or for comfort measures
  • Ensure end of life medications are prescribed and dispensed for residents at beginning of this phase, not the end (see medication form)
  • Continue to monitor symptoms especially pain, anxiety, dyspnea, constipation
  • Help prepare residents and family for changes, especially physical, in last hours of life

4. Grief & Bereavement


  • Provide after death care & guidance for family about funeral arrangements
  • Communicate and provide support to other residents
  • Acknowledge death, i.e. send sympathy card, hold memorial services
  • Provide written material regarding loss, bereavement and available resources
  • Offer bereaved family members the opportunity to attend a peer support group