Collaborative care model of HKEC CGAT and RCHE supported by JCECC for dying in residential care home for the elderly

This abstract has open access
Abstract Description
Submission ID :
HAC800
Submission Type
Authors (including presenting author) :
Wong CW (1), Lam CY (1), Choy YL (1), Siu TS (3), Po MY (2), Ho SK (1), Wan MC (1)
Affiliation :
(1) Division of Geriatrics, Department of Medicine & Geriatrics, Ruttonjee & Tang Shiu Kin Hospitals, (2) Community Healthcare Services, HKEC, (3) Community Geriatric Assessment Team, Ruttonjee & Tang Shiu Kin Hospitals
Introduction :
With the amendment on Coroners Ordinance in June 2024, death of a resident in residential care homes for the elderly (RCHE) is not a reportable death if they fulfilled prerequisite conditions. Dying in preferred place is one of the elements of good death. However, because of insufficient supportive measures, dying in RCHE is difficult to implement. A possible solution is to enhance the capacity of RCHEs in supporting terminally ill residents with collaboration between hospital and RCHE. Although Jockey Club End-of-Life Community Care project (JCECC) and its participating RCHEs also provide end-of-life (EOL) service for residents, there was no formal communication with CGAT. To improve EOL care of residents, CGAT, RCHE and JCEE EOL team have agreed collaboration since August 2024. This paper is to illustrate the collaborative care of CGAT and RCHE supported by JCECC for residents preferred dying in RCHE.
Objectives :
1. Establish communication platform and streamline EOL care for residents among CGAT, RCHE and JCECC EOL team. 2. Develop service model for care of residents preferred dying in RCHE.
Methodology :
CGAT discussed EOL care with patients with advanced irreversible chronic medical illness and their family. Then, choice of dying place (RCHE or hospital) was discussed by RCHE and JCECC EOL team. Resident preferred RCHE death, logistic for funeral service would be arranged with support by JCECC. CGAT applied “needs based coding system” to highlight the level of care needs for resident and facilitate communicate with RCHE. 1. Green signified relatively stable 2. Yellow signified deteriorating or unstable 3. Red signifies last days of life CGAT provides medical care till patient approached final days of their lives (red code). Patient was handover to the designated community doctor and nurse supported by JCECC. EOL room in RCHE would be provided for residents to receive continuous care and accompanied by family. Resident preferred dying in RCHE would be certified by the community doctor and certificate of the Cause of Death would be completed. After death registration with certificate
Result & Outcome :
Dying in place becomes a real option Since August 2024 till December 2024, there were two residents completed their life journey in RCHE under co-care of CGAT, RCHE and JCECC EOL team. The caring process from RCHE to funeral service was smooth. One patient had only one and another patient did not have hospital admission before death since collaborative care. Collaboration service model was developed (Figure). Conclusion Collaboration between hospital and community sector for RCHE residents with terminally ill make dying in RCHEs a real option. Implementation of EOL care with dying in place not only offer the choice of good death for RCHE residents but also reduce accident and emergency department attendance and unnecessary hospitalization for futile treatment.
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