What are the five stages of palliative care?

Palliative care is crucial for those facing life-limiting illness. It offers more than just medical help — it provides comprehensive support that improves the quality of life for patients. At MACG, we focus on personalised, compassionate residential aged palliative care. We ensure that every resident and their families receive support that’s tailored to their specific needs.

Palliative care involves a range of medical and emotional services designed to ensure people feel as comfortable as possible while receiving care. Whether in hospice care, residential aged care, or at-home care, the goal is to provide dignity, relief, and support at every stage.

In this blog, we'll break down the 5 stages of palliative care:

• Stable: The terminal illness is managed, and care plans are created.
• Unstable: When conditions change, and care plans need adjustments.
• Deteriorating: Focus shifts to end-of-life care.
• Terminal: Intense care focusing on comfort and dignity.
• Bereavement: Support continues for families after a loss.

We'll explore each stage in detail, discussing how MACG helps residents and their families at each point. Our goal is to prepare you for the journey ahead and ensure you have the necessary support at every step.

Stage 1 - Stable

At this stage, a resident’s condition is generally under control, allowing for thoughtful planning of future care. For individuals who need palliative care for Parkinson’s disease or other degenerative conditions, early planning ensures that as the disease progresses, care can be adapted smoothly to support their evolving needs.

For residents living with conditions such as cancer or neurological disorders, the stable stage allows for comprehensive planning to ensure their care aligns with their personal needs and preferences.

The first stage of palliative care, known as the "Stable" stage, is crucial for setting a strong foundation for future care. Palliative care begins here with the development of a tailored care plan.

Developing a comprehensive care plan

The focus for care professionals at this stage is on creating a plan that comprehensively addresses the resident’s medical, emotional, and spiritual needs. The process involves:

• Assessment of Needs: Gathering detailed information about the resident’s medical history, current health status, and personal preferences.
• Goal Setting: Working with the resident and their family to establish clear, achievable goals for both short-term management and long-term care.
• Care Coordination: Planning out who will be responsible for each aspect of care and how different care needs will be met.

Collaborative care implementation

We work closely with residents and their families to ensure care plans are part of palliative care that adapts as needs evolve. This stage typically involves:

• Regular Meetings: Reviewing the plan with residents and families to ensure ongoing alignment.
• Education and Support: Helping families understand care procedures and how they can assist.

Community Resources: Connecting families with external services to provide additional emotional and mental support.

Stage 2 - Unstable

When sudden health changes occur, such as unexpected complications in palliative care for heart failure, swift adjustments to treatment are necessary. Palliative care is often adjusted frequently in this phase to address new challenges.

Navigating the unstable stage

During this phase, it's critical to quickly identify and respond to new physical symptoms, such as prognosis changes, pain, breathlessness, or nausea. The aim is to stabilise the resident’s condition while adapting care strategies.

Importance of emotional preparation

Patients and their loved ones may experience heightened distress and uncertainty during this stage. We provide:

• Open Communication: Keeping residents and families informed about condition changes and what they can expect.
• Psychological Support: Counselling and therapy to help families cope with stress.

Adjusting care plans

Adjusting care plans in response to instability involves several key actions:

• Rapid Assessment: Conducting swift assessments to understand the new symptoms or changes in the resident’s condition.
• Multidisciplinary Collaboration: Our multidisciplinary team collaborates to revise the care plan, addressing all medical, emotional, and spiritual needs. This may include adjusting medication dosages, introducing new therapies, or modifying existing treatment protocols.
• Enhanced Support: The frequency of monitoring will be increased to provide additional support and ensure the resident’s safety and comfort.

Stage 3 - Deteriorating

The "Deteriorating" stage in palliative care is marked by a notable progression in the resident’s illness, signalling a shift towards end-of-life care. This stage requires a thoughtful realignment of care priorities to focus more on comfort rather than curative treatments, acknowledging the resident’s changing health dynamics.

As a condition progresses, residents may experience increased dependency on caregivers. For example, those receiving palliative care for dementia patients often require more hands-on assistance, while individuals in palliative care for lung conditions may need enhanced breathing support.

This stage often involves discussions about decisions about treatment options, symptom control, and preparation for terminal care.

Our approach to transition in care priorities

We handle this sensitive transition with great care and professionalism, ensuring that both the resident and their family are prepared for the changes to come. Our approach includes:

• Comprehensive Communication: Keeping residents and families informed about the expected changes in health conditions and care strategies.
• Advance Care Planning: Encouraging discussions about advance care directives and residents’ preferences for end-of-life care helps respect their' wishes as their condition evolves.
• ‍Emotional and Psychological Support: Continuous emotional support is provided to help the resident and family cope with the emotional burden of deteriorating health.

Techniques and services for comfort and dignity

During the Deteriorating stage, MACG focuses on techniques and services that prioritise the resident’s comfort and dignity:

• Pain Management: Employing advanced pain control techniques, including medication adjustments and alternative therapies like massage or relaxation techniques.
• ‍Symptom Control: Addressing non-pain symptoms such as nausea, breathlessness, or fatigue with appropriate interventions tailored to the resident’s needs.
• ‍Palliative Sedation: In cases where symptoms become unbearable, palliative sedation is considered a compassionate option to relieve suffering, always in accordance with the resident’s and family’s wishes.

Enhancing the care environment

Ensuring the resident’s environment is calm, comfortable, and reflective of their preferences is also crucial. This may involve:

• Adjusting the lighting and noise levels in the resident’s room.
• Personalise the space with items the resident finds comforting, such as photos, favourite bedding, or music.

Stage 4 - Terminal

The terminal care stage of palliative care focuses on making the resident as comfortable as possible in their final days. At this stage, care is fully focused on symptom management, dignity, and ensuring that families are well-supported. Home care or hospice care may be considered, depending on the resident’s wishes and medical needs.

In the Terminal stage, the primary goal shifts from prolonging life to maximising comfort. This involves:

• Intensive Symptom Management: Rapid response and adjustment of treatments to alleviate pain and other distressing symptoms.
• ‍Consistent Monitoring: Frequent assessments to adapt care as needed, ensuring that all physical discomforts are promptly addressed.
• Family Involvement: Family members should be kept informed and involved in care decisions to honour the resident’s wishes.

Importance of spiritual care

Spiritual care becomes particularly significant during the Terminal stage as residents often reflect on their lives and seek peace. MACG supports the spiritual needs of residents by:

• Spiritual Counseling: Offering access to spiritual counsellors who can engage in meaningful conversations, including discussing life’s purpose, reconciliation with others, and expressing unresolved feelings.
• Creating a Peaceful Environment: Arranging for rituals or practices that align with the resident’s spiritual beliefs, such as prayer sessions, reading spiritual texts, or listening to spiritually significant music.
• Family Integration in Spiritual Practices: Encouraging family members to participate in spiritual activities at the resident’s request fosters unity and emotional support.

Stage 5 - Bereavement

Grief support is a vital part of palliative care, ensuring that families continue to receive care even after their loved one has passed — bereavement counselling services care can be an ongoing and vital resource for families.

The role of ongoing support and community resources

Continued support is vital for long-term healing. MACG connects bereaved individuals with community resources that can offer additional support, such as:

• Support Groups: Facilitating connections with local support groups where individuals can meet others who have experienced similar losses, fostering a sense of community and shared understanding.
• ‍Educational Resources: We provide access to literature and workshops on grief and loss to help people understand and navigate the bereavement process.
• ‍Wellness Programs: Encouraging participation in activities and programs focusing on physical and mental health, which are crucial during healing.

Navigating palliative care with MACG

Navigating the journey of palliative care is deeply personal and challenging for residents and their families. Understanding the five stages prepares everyone for the necessary transitions and ensures that each stage meets specific needs, from diagnosis to post-loss support.

At MACG, we provide comprehensive and empathetic care throughout all palliative care stages. We encourage those needing palliative care services to consider us their partner. 

Please contact our Melbourne palliative care team for more information on how we can assist you through each stage of care. We are here to support you every step of the way, extending care beyond treatment to true compassion and understanding.