END-OF-LIFE care can be a difficult topic for Wimmera residents to talk about, and decisions are only made harder by the limited services available to rural patients.
However, health services are encouraging people to have those difficult conversations early.
Wimmera Cancer Centre manager and cancer nurse practitioner Carmel O'Kane said the centre's palliative care services covered the Horsham municipality, as well as the Yarriambiack, West Wimmera and Hindmarsh shires.
"Towns such as Edenhope and Kaniva also have their own district nurses. At Horsham hospital, we have a dedicated room for palliative care which has an adjoining room for family members to stay," she said.
"While that's the only dedicated room, we can take any other patients into the hospital. A lot of residential facilities or nursing homes can also provide palliative care services where our nurses go see the patients."
She said the palliative care sector was facing many challenges in the region, including the lack of a palliative care unit.
"For people who are coming close to the end of their lives and can't be managed at home, they have to come into a public hospital. While we do our best to care for them and make it as homely as possible, it's still a hospital," she said.
"What we'd love and what we're working towards is having district nurses who can go out multiple times a week, or stay overnight, to provide more care.
"We're doing a project at the moment with the Department of Health and Human Services to put in after-hours support so that people at home can call us anytime."
Ms O'Kane said end-of-life care services varied case-by-case.
"Everyone's different. Those who have been living in aged care facilities their whole lives don't want to leave because that's their home," she said.
"A lot of people who are isolated or live on farms want to stay there. It's more about whether they have someone there who can care for them. Sometimes it's harder to die at home too, especially for loved ones."
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Rural Northwest Health provides palliative care services for its community and residents.
For aged care residents, the health service employs a team of link nurses whose role is to initiate the palliative discussion with family members and then support residents and their families through their care.
Link nurse Bronwyn McIntyre said it was her role to help residents to complete an advance care directive.
"We link the resident with their doctor and other health professionals to ensure everyone is on the same page for treatment and for the wishes of the resident or family," she said.
"We do everything we can to help each resident living with a terminal illness, to live their life as fully and as comfortable as possible.
"The last few weeks in particular is the most important phase because the needs of the resident are much higher. This is when increased services and support are essential and we make sure the team is coordinated to ensure the very best in person-centred care is delivered."
Rural Northwest Health has acute wards to meet the needs of any patient entering the palliative process.
West Wimmera Health Service works with Wimmera Hospice Care to provide palliative services across the region.
Clinical operations manager Ann Merrett said this allowed people to remain close to their and within their community when they entered palliative care.
"We have referral pathways to oncologists and palliative physicians if we require advice and guidance," she said.
The service also uses telehealth for consultations between patients, families, specialists and nursing staff. Ms Merrett said a number of staff had palliative care qualifications.
Member for Lowan Emma Kealy said the region was lucky to have fantastic people working in palliative care.
"I went through the Wimmera Cancer Centre a few weeks ago and I had the opportunity to meet two of the fabulous care nurses - they really do an amazing job," she said.
"They are there for people when they need it most at the end of their life. It's not just about offering medical support either, they provide emotional care, which makes an enormous difference to both the patient and their families."
Ms Kealy said access to palliative care was vital for the region.
"Just because we live in regional areas doesn't mean we have to miss out on services. People who work in health care here often have grown up in the region and they know people personally, so they provide an extra level of care," she said.
Ms Kealy said she would like to see more options for people who wanted to die in their own home.
"What we need is an expansion of palliative care services in the home. This will allow people to die where they want to and not necessarily in a clinical environment like a hospital. We need sufficient resources to support people to die with dignity in an environment of their choosing," she said.
Benefits to pre-planning care
Wimmera Health Care Group palliative care team leader Clare Petering said it was common for people to only think about end-of-life care when it was actually needed.
"It's not that often that we come across people who are fully prepared for end-of-life," she said.
"Early planning is the key. It helps reduces stress, particularly for carers and family. It's also important to talk to family members about what's important for the person who is sick.
"We focus our day-to-day stuff on making sure people are living as well as they can. It's not about dying, it's about what we can do to make sure people live as well as they can with a life-limiting illness. One of the hardest parts is making sure the family is happy as well."
Wimmera Cancer Centre manager and cancer nurse practitioner Carmel O'Kane said it was important for people to have difficult conversations about palliative care sooner rather than later.
"A lot of people when we mention palliative care, find it very scary and they think it's about dying. But it's actually about providing that quality care early so people can live as long as possible," she said.
"We tell people not to be frightened about what's going to happen, rather we give them information if they're not sure how to look after a loved one who is sick. That could just be giving them advice about how to roll them over or help them to the toilet. Loved ones just need that reassurance and support."
She said people could come into the Wimmera Cancer Centre any time to talk to staff about caring for a sick loved one.
"We can also have nurses go out and see them if needed, and we're also utilising telehealth more," she said.
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