WA End-of-life And Palliative Care Strategy 2018-2028
Implementation Plan One2019-2021WA End-of-life and Palliative CareStrategy 2018-2028Version: 12 June 2019
ContentsIntroductionDevelopment of Implementation Plan One33Overview of Priorities5Three-year implementation cycles6Statewide responsibilities7Local responsibilities7Overview of Building Block implementation8Themes9Immediate-term actions10Medium-term actions17Longer-term actions19Acronyms20Appendix One – Action Plan template212
IntroductionThe aim of Implementation Plan One is to guide implementation of the WA End-of-life andPalliative Care Strategy 2018-2028 (Strategy) at both a state and local level. The Strategy wasdeveloped over 2015-2018 through extensive consultation with the sector, and launched in May2018.The WA Cancer and Palliative Care Network (WACPCN) hosted the End-of-life and PalliativeCare Strategy Implementation Forum 2018 (Strategy Implementation Forum) in September2018 to consult the sector on implementation of the ten-year Strategy. The outcomes of theStrategy Implementation Forum were detailed in the Outcomes Report: End-of-life and PalliativeCare Strategy Implementation Forum 2018 (Outcomes Report) released in March 2019, andforms the foundation of Implementation Plan One.The Joint Select Committee (JSC) inquiry into End of Life Choices occurred over 2017-2018.The Report of the Joint Select Committee on End of Life Choices, My Life, My Choice, washanded down on 23 August 2018 and made 24 recommendations, of which 12 relate to end-oflife and palliative care.Implementation Plan One will address the Strategy implementation in-line with the OutcomesReport, and the 12 JSC recommendations relating to end-of-life and palliative care in tandem.Implementation Plan One also takes into account the Sustainable Health Review: Final Reportto the Western Australian Government 2019 (SHR Final Report) released in April 2019.Development of Implementation Plan OneThe WA Cancer and Palliative Care Network (WACPCN), WA Department of Health, led andcoordinated the development of Implementation Plan One. The End-of-life and Palliative CareAdvisory Committee (EOLPCAC) was the overarching governance group that contributed to itsdevelopment.The Strategy Implementation Forum provided the sector opportunity to identify Building Blocksfor implementation in the immediate-term, medium-term and longer-term, and suggestedactions, leaders and measures of progress. Implementation Plan One was developed with theOutcomes Report and JSC recommendations for end-of-life and palliative care as thefoundation. Implementation of the Strategy in-line with the Outcomes Report and therecommendations from the Report of the Joint Select Committee (JSC) on End of Life ChoicesMy Life, My Choice will occur in tandem.The Strategies and Recommendations in the SHR Final Report seek to move away from apredominantly reactive, acute, hospital-based system, to a system with a focus on prevention,end-of-life care, and seamless access to services at home and in the community, along withother areas. “A dignified end of life will become part of community conversations, with greaterplanning and support for people to have more choices and access to appropriate end of lifecare” (SHR Final Report). Strategy 3 ‘Great beginnings and a dignified end of life’ of the SHRFinal Report aligns with the Strategy’s Priorities and Implementation Plan One to influencecultural change in end-of-life and palliative care via a staged approach. Recommendation 9 ofthe SHR Final Report to ‘achieve respectful and appropriate end-of-life care and choices’ and itspriorities in implementation directly align with Implementation Plan One and include: Directions of My Life, My Choice: Report of the WA Parliament Joint Select Committeeon End of Life Choices progressed for greater use of Advance Health Directives,expansion of successful palliative care models, and patient choices.3
Use of ‘realistic medicine’ and ‘compassionate communities’ models with individuals,local communities, patients, carers and health professionals to promote and integratesocial approaches to dying, death and bereavement in everyday lives.Introduction, evaluation and spread of a model for community-based wrap-aroundservices for supporting older people with complex chronic illness and cognitiveimpairment dementia involving GPs and multidisciplinary services.Introduction, evaluation and spread of outreach models to improve linkages betweenhospital and residential aged care facilities in partnership with primary care based onmodels such as CARE-PACT in Queensland, building on the current Residential CareLine.Stakeholders in end-of-life and palliative care were consulted in Implementation Plan One’sdevelopment to ensure the actions were achievable and the views of the broader health,community and aged care systems were accurately represented given the responsibility ofeveryone to implement.The Vision is to improve the lives of all WesternAustralians through quality end-of-life and palliative care.4
Overview of Priorities5
Three-year implementation cyclesThe Strategy is a high-level document providing a ten-year vision for improving the lives of allWestern Australians through quality end-of-life and palliative care. The six priority areas requirea long-term approach to implementation to achieve culture and population change.The Implementation Plans will be broken down into three-year time periods, with this beingImplementation Plan One. This approach is founded on the end-of-life and palliative carelandscape changing with time in relation to people, politics and funding. A phased approach toimplementation allows for flexibility given the changing landscape, and facilitates theinvolvement of future leaders and ideas throughout the Strategy’s ten-year life-span.Implementation Plan One is a guide and allows for flexibility. Implementation Plan One willaddress the Building Blocks identified for implementation in the immediate to medium-term, withthe Building Blocks identified as longer-term addressed in future Implementation Plans.It does not diminish the importance of Priorities or Building Blocks not identified forImplementation Plan One. Stakeholders may identify other Building Blocks to action within theirown systems. These Building Blocks may be addressed by local action and/or raised forimmediate-term action to address at future Strategy Implementation Forums andImplementation Plans over the Strategy’s ten-year life.The Strategy Implementation Forum provided the sector opportunity to identify Building Blocksfor implementation in the immediate-term, medium-term and longer-term. It is intended thatStrategy Implementation Forums will continue with the sector to review implementationprogress, provide opportunity for providers to share successes/lessons learnt in implementation,and assist guide the development of future Implementation Plans over the Strategy’s ten-yearlife.ImplementationPlan One2019-2021ImplementationPlan Two2022-2024ImplementationPlan Three2025-2027Review 20286
Statewide responsibilitiesThe WA Cancer and Palliative Care Network (WACPCN) will lead and oversee the statewideimplementation of the Strategy in its role as System Manager, with responsibility for facilitationof actions with statewide impact that do not have a HSP or stakeholder responsibility.The Minister for Health and/or WA Health is responsible for addressing JSC recommendations7-18 relating to end-of-life and palliative care (12 recommendations in total). These have beenincorporated into Implementation Plan One.The WACPCN will provide statewide leadership and stewardship, and monitor performance viasystem-wide trends and data collection.Local responsibilitiesIt is intended that Implementation Plan One guides action by Health Service Providers and nongovernment organisations to address local needs through local action and evaluation plans(including planning and reporting mechanisms). The Strategy and Implementation Plan processallows for flexibility to identify and action areas most relevant to a stakeholder’s health system.HSPs and stakeholders may use the Action Plan Template in Appendix One to prepare andimplement an Action Plan aligned to the Strategy and using Implementation Plan One as aguide. It is recommended that Action Plans address each of the six Priorities in the Strategyand outline the actions relevant to their respective health system. This may be done inconsultation with the WACPCN on behalf of the Department of Health.The NSQHS Standards, particularly Standard 5. Comprehensive Care that aims to ensure thatpatients receive comprehensive healthcare that meets their individual needs, and considers theimpact of their health issues on their life and wellbeing, aligns with the aims of ImplementationPlan One. Important documents for the delivery of high-quality care include the Nationalconsensus statement: Essential elements for safe and high-quality end-of-life care 2015, andNational consensus statement: Essential elements for safe and high-quality paediatric end-oflife care 2016. These NSQHS Standards and documents may be relevant when considering,and to guide, implementation in-line with service accreditation.Implementation Plan One was developed in consultation with HSPs and other stakeholders sothat the actions can be brought to reality. These stakeholders are well placed to lead, convene,and coordinate local initiatives to implement the Strategy, making these priorities, their priorities.WACPCN will support stakeholders to connect and collaborate to enable the provision of anintegrated, coordinated and strategic approach to influence policy, purchasing, workforce andplanning. Implementation will require the invaluable commitment and collaboration of the WAend-of-life and palliative care community, and other key stakeholders across health, communityand aged care services to ensure success. Many systems, services and programs havealready progressed local Implementation Action Plans that contribute to implementation in-linewith the Strategy Priorities and Building Blocks.WA End-of-life and Palliative Care Strategy2018-2028Implementation Plans - One, Two ThreeLocal Action Plans7
Overview of Building Block implementationThe following maps the Building Blocks under each of the Priorities, whether it was identified at the Strategy Implementation Forum forimmediate, medium or longer-term action, and the Plan to address.KeyImmediate-term and Building blocks identified and suggested for implementation in Implementation Plan Onemedium-termLonger-term Building Blocks to be addressed in future Implementation Plans and may require a longer time-frame toactionHSPs and other stakeholders are encouraged to address any Building Block they identify of high importance in their health system.Action inPlan to addressPriority One: Care is accessible to everyone, everywhere1.Improve equity of accessImmediate-termImplementation Plan One2.Improve access to care for Aboriginal peopleLonger-termLocal action and future Plans3.Improve access to care for Culturally and Linguistically Diverse communitiesLonger-termLocal action and future Plans4.Strengthen care for children with a life-limiting illnessLonger-termLocal action and future Plans5.Improve access to care for condition-specific groups (e.g. people with dementia or thoseexperiencing mental health issues)Longer-termLocal action and future Plans6.Improve access to care for marginalised groups (e.g. homeless people and refugees andLGBTIQ communities)Longer-termLocal action and future PlansMedium-termImplementation Plan OneLonger-termLocal action and future PlansPriority Two: Care is person-centred7.People and their family/carer co-designing care with health teams, to include: 8.culturally respectful and comprehensive careopportunities to talk about and plan for death, including ACPCare is centred on people and their family/carerPriority Three: Care is coordinated9.Strengthened referral pathways between end-of-life and specialist palliative care teamsImmediate-termImplementation Plan One10.Adequate resources to support health, community and aged care providers deliveringImmediate-termImplementation Plan One8
end-of-life and palliative carePriority Four: Families and carers are supported11.Improved practical advice and support for familiesMedium-termImplementation Plan One12.Improved awareness by health, community and aged care providers regarding familyaccess to bereavement supportLonger-termLocal action and future PlansPriority Five: All staff are prepared to care13.Improved health, community and aged care provider understanding of end-of-life care, andappropriate referrals to specialist palliative careImmediate-termImplementation Plan One14.The generalist healthcare workforce supported and mentored to increase capacity,knowledge and skillsLonger-termLocal action and future Plans15.Improved succession planning for an ageing workforceLonger-termLocal action and future Plans16.Workforce better equipped to support an ageing populationLonger-termLocal action and future PlansPriority Six: The community is aware and able to care17.Increased awareness and uptake of ACPLonger-termLocal action and future Plans18.Improved public understanding of end-of-life and palliative careImmediate-termImplementation Plan OneThemesThe suggested actions against each building block have been themed according to the following categories:FundingPathways, Models, PolicyGOPC, ACP, CPDP, Clinical IndicatorsEducation, Champions, Mentoring, Capacity BuildingCommunicationNavigate health system9
Immediate-term actionsBelow are the suggested actions for the Building Blocks identified at the Strategy Implementation Forum for implementation in theimmediate-term, recommended measures, and the JSC recommendations that align. The recommended measures can be used tomeasure progress, or as flags to identify particular actions or Building Blocks that may require higher priority to action in an area’s healthsystem. The suggested actions and measures have been taken from the Outcomes Report and from consultation with other divisions andjurisdictions.Priority One - Care is accessible to everyone everywhereBuilding Block 1. Improve equity of accessRanking 1 Rating 2.75Suggested actions1. Identify and remedy access gaps: define access needs of population who is missing out on specialist palliative care? do they need it? is EOL care adequate? who is missing out on EOL care?2. Implement strategies that address access gaps in levels of care deliveryfor services in: Inpatient Unit Consultation Outpatient Clinic Community Regional Consultation3. Address gaps between State and Federal funding (data) to meet nationalstandards4. Identify flexibility in funding models to follow patientRecommended measures Analyse data on who did/didnot access palliative care –existing data, death reviews Compare # referrals made to# referrals accepted Gap between service andnational data and fundingtargets Data on # deaths and location Identify appropriate KPIs fromPCOC dataAligned JSC recommendations10 - unmet demand14 - activity and spend9 - pt perspective review of service deliverymodels and accessibility7 - inpatient sp pc in northern suburbs8 - community providers funded to meetdemand13 - Regional pc funded to meet demand12 - policy development and governance forpc in WACHS5. Support roll-out of GOPC to sp pc and EOL care sector to enable shareddecision-making (SHR Realistic Medicine)6. Address location, access and staffing of inpatient services7. Support for the RPCP to continue to build workforce capacity in EOL carein country WA, both financial and governance8. Integrate sp pc into formal care pathways e.g. Chronic ObstructivePulmonary Disease, end stage cardiac, Heart Failure10
The sector identified that a focus is required for: Neonatal to paediatric Aboriginal Communities Mental health Disability sector Complex patients (expensive and vulnerable) Rural and remote11
Priority Six - The community is aware and able to careBuilding Block 18. Improved public understanding of end-of-life and palliative careRanking 2 Rating 2.57Suggested actionsRecommended measures1. Develop statewide media guidelines for public awareness campaigns foruse at local level. Multi-level approach: apps and flyers patient stories forums online resources – webinar etc. public debates2. Review messages and services for sp pc in hospitals regarding theprocesses and level provided (less medical and make it specific topatients)3. Engage with health insurance providers for improved cover for sp pc andEOL care and aged care facilities4. Support Compassionate Communities projects for communities in relationto funding and sustainability (SHR Compassionate Communities)Survey of public awarenessand understanding of EOLand sp pc - baseline andfollow-up after campaign Increase in # of ACPconversations, AHDs andcommon-law directives Attendance at forums Increase in # of referrals to sppc Increase in # of training Increase in # of GOPC inhealth, community and agedcare servicesAligned JSC recommendations11 (11.1) - consistent defn of pc byprofessionals11 (11.2) - info and education services toprofessionals and community on pc17 (17.2) - educate/health promotion forcommunity on EOL decision making11 (11.4) - pc info and community hotline9 - pt perspective review of service deliverymodels and accessibilityTopics for consideration5. Develop consistent key messages across the state using Strategydefinitions of EOL and PC for: hospitals and facilities - have conversations; respect family wishesand access public - sp pc; clear EOL care language; communication about deathand dying, expectations to change views and expectations of dying both: Start conversation earlier: ACP; GOPC; CPDP6. Define and navigate the healthcare system for people and theirfamily/carer, including what’s involved and available before hospital, andin hospital, including staff, roles and paperwork7. Promote public awareness of co-design between a person, theirfamily/carers and their health team12
8. Raise awareness of out-of-hospital crisis planning, especiallyemergencies when not in hospital or at homeTarget9. Engage with consumer groups10. Develop promotional information for community, including: primary and secondary schools (i.e. via School Health Nurses) over 55s aged care11. Provide and support education of staff champions in hospitals, facilitiesand GPs, including promotion of ACP and staff leading by example byhaving an AHD to be informed and communicate the informationThe sector identified that any information produced would need to be tailored to make it specific to an area, culture, or language.13
Priority Three - Care is coordinatedBuilding Block 10. Adequate resources to support health, community and aged care providers deliveringend-of-life and palliative careRanking 2Rating 2.57Suggested actionsRecommended measures1. Map and address gaps for provider’s needs with existing resources withdata issues to deliver EOL and PC 2. Implement ongoing support for GPs in EOL and PC education andnetworks3. Promote billable items for sp pc and EOL care to create data and activity4. DOH to advocate for ACP Medicare rebates for GPs and NursePractitioners5. Advocate and support access to Home and Community Care (HACC)services, particularly for 65 year olds6. Assess psychosocial care resourcing – governance, responsibility,funding, service benchmarks7. Resource sp pc community providers and inpatient units to meet demand8. Investigate and fund stand-by model for sp pc community providerreferrals9. Address barriers that enable service providers to better work together i.e.communication and IT systems10. Support projects that utilise innovative technology to connect teams toteams, and people to teams i.e. TelePalliative Care11. Investigate application of a navigator function (SHR Interim Report 2018) anddeath doulas to connect and support people within the health system12. Strengthen pathways, support and education to support aged care deliverEOL careImplementation Plan Onecompleted, ImplementationPlans Two and Threedeveloped Education plan Billable items with Medicare,IHPA and ABF Quality pathways andprocesses in place to supportservice partnershipsAligned JSC recommendations14 - activity and spend13 - regional pc funded to meet demand8 - community providers funded to meetdemand7 - inpatient sp pc in northern suburbs12 - policy development and governance forpc in WACHS11 (11.1) - consistent defn of pc byprofessionals11 (11.2) - info and education services toprofessionals and community on pc11 (11.3) - knowledge sharing by sp pc withgeneralists11 (11.4) - pc info and community hotline15 - Educate professionals on right torefuse medical treatment16 - Educate professionals on right torefuse food and water (includes aged care)17 (17.1) - Educate professionals curativeto non-curative and futile treatment18 - Guidelines on terminal sedation byprofessionals13. Review alternative models of service delivery including aged caredelivering palliative care e.g. step-down units14. Establish and standardise governance committees, including WACHSregional committees, and application of regional governance in metroregions14
Priority Five - All staff are prepared to careBuilding Block 13. Improved health, community and aged care provider understanding of end-of-life care, andappropriate referrals to specialist palliative careRanking 3Rating 2.33Suggested actionsRecommended measures1. Support (financial/governance) for MPaCCS to continue to buildworkforce capacity in EOL care in residential care Audit of GOPC from sp pc toGP11 (11.2) - info and education services toprofessionals and community on pc2. Support roll-out of GOPC, ACP resources and CPDP beyond hospitals toenable shared decision-making (SHR Realistic Medicine) 11 (11.3) - knowledge sharing by sp pc withgeneralists3. Re-design funding models to support EOL care activity i.e. financialincentive for GOPC, ACP and CPDPEvidence of GOPC, ACPresources and CPDP beyondhospitals 4. Improve access to quality clinical education with standardised contentand staff release to attendFinancial incentives in placefor GOPC, ACP and CPDP Staff access to quality clinicaleducation on sp pc and EOLcare5. Enable champions and services to educate sector and leverage theimportance of EOL and sp pc within: NGOs GPs public mental health Palliative Care WA Increase in coding for GOPC,CPDP and ACP in hospitalsAligned JSC recommendations17 (17.1) - Educate professionals curativeto non-curative and futile treatment11 (11.1) - consistent defn of pc byprofessionals11 (11.4) - pc info and community hotline15 - Educate professionals on right torefuse medical treatment16 - Educate professionals on right torefuse food and water (includes aged care)18 - Guidelines on terminal sedation byprofessionals6. DoH to advocate to Commonwealth for greater education in aged care7. Utilise and promote Health Pathways (WAPHA) to influence primary care8. Process to improve two-way communication of patient informationbetween health services (i.e. hospitals) and primary care (i.e. GPs),particularly at discharge: GOPC, ACP, discharge summary, OutpatientLetter9. Support two-way sharing of information between St John Ambulance andproviders10. Process to improve coordination of services between providers: Specialist palliative care and GPs Community and Home and Community Care (HACC) services11. Support coders to identify GOPC, CPDP and ACP to support thecollection of meaningful data and translate to meaningful action15
Priority Three - Care is coordinatedBuilding Block 9. Strengthened referral pathways between end-of-life and specialist palliative care teamsRanking 3Rating 2.33Suggested actionsRecommended measuresAligned JSC recommendations1. Increase in number of allied health professionals in sp pc, particularlySocial Workers Increase in # of allied healthprofessionals in sp pc11 (11.1) - consistent defn of pc byprofessionals2. Promote and support ongoing quality staff education: # and nature of existingreferral pathways11 (11.2) - info and education services toprofessionals and community on pc Audit # of referrals,appropriateness, patientoutcome and ongoing care11 (11.3) - knowledge sharing by sp pc withgeneralists3. Funding to support care-coordination and referrals – suggest jointlyfunded by HSPs and NGOs (MOUs) Patient/family experiencesurveys of patient journey10 - unmet demand4. DoH to advocate for Medicare and ABF to provide financial incentive fortransfer of information and referral to sp pc # of re-admissions / faileddischarge # of people dying in hospitalfollowing unplannedadmission (chronic diseases) Increased access to fundingassociated with transfer ofinfo/referral awareness (timeliness) of palliative care what services are available and when to refer how to have difficult conversations5. Design and promote specific referral criteria for specialist pc6. Develop centralised referral system and advice for accessing pc services7. Utilise and promote Health Pathways (WAPHA) to influence primary care8. Design and promote alternative referral pathways to increase access(current sp pc community provider resources limited to terminal phase): Map existing pathways / services Strengthen / re-design Continual improvement / review of referral pathway11 (11.4) - pc info and community hotline14 - activity and spend8 - community providers funded to meetdemand12 - policy development and governance forpc in WACHS13 - regional pc funded to meet demand16
Medium-term actionsBelow are the suggested actions for the Building Blocks identified at the Strategy Implementation Forum for implementation in themedium-term, recommended measures, and the JSC recommendations that align. The recommended measures can be used tomeasure progress, or as flags to identify particular actions or Building Blocks that may require higher priority to action in an area’s healthsystem. The suggested actions and measures have been taken from the Outcomes Report and from consultation with other divisionsand jurisdictions.Priority Four - Families and carers are supportedBuilding Block 11. Improved practical advice and support for familiesRanking 4Rating 1.86Suggested actionsRecommended measuresAligned JSC recommendations1. Establish formal committee of carers groups to strategically plan andcoordinate services and tools that improve practical advice and supportfor families. Committee to: Establishment of a formalcommittee9 - pt perspective review of service deliverymodels and accessibility Updates from formalcommittee on coordination ofservices to EOLPCAC11 (11.1) - consistent defn of pc byprofessionals 2. Reformat consumer-focused websites to display greater empathy towardscarers/families with links/access to practical information and adviceEvidence of family/careraccess to resources or events Evidence of family/carerassessment tools in services3. Support access to Compassionate Communities projects for families andcarers in the local area (SHR Compassionate Communities) Services linking actions toaccreditation process andrelevant consumer councils identify existing resources, gaps and overlap inform and coordinate services link in with existing promotion of services and activities4. Promotion of resources and events that aim to explain family and carerrole in EOL and PC11 (11.2) - info and education services toprofessionals and community on pc11 (11.4) - pc info and community hotline17 (17.1) - Educate professionals curativeto non-curative and futile treatment17 (17.2) - Educate/health promotion forcommunity on EOL decision making5. Support roll-out of family/carer assessment tools (such as CSNAT andSPICT) including governance, policy and support17
Priority Two - Care is person-centredBuilding Block 7. People and their family/carer co-designing care with health teams, to include: culturally respectful and comprehensive care opportunities to talk about and plan for death, including ACPRanking 5Rating 1.71Suggested actionsRecommended measuresAligned JSC recommendations1. Support DOH, HSPs and NGOs to use and/or incorporate co-design ofcare into area’s consumer/carer engagement framework and promote # of ACP sessions annuallydelivered to community9 - pt perspective review of service deliverymodels and accessibility2. Support and promote roll-out of GOPC, ACP and CPDP policies andresources with HSPs, community services, residential care providers andprimary care providers to enable shared decision-making (SHR Realistic Increase in # of ACPconversations, AHDs andcommon-law directives11 (11.1) - consistent defn of pc byprofessionals Evidence of focus onconsumer / lived experience Identify indicator for whatconsumer defines as success& survey on whether thesehave been achieved (i.e.GOPC patient experiencesurvey)Medicine)3. Support and promote clinician staff development on how to work withfamilies/patients to co-design care and difficult conversations(behavioural change)4. Re-design funding models to support co-design of care i.e. financialincentive for GOPC and ACP5. Promote use of clinical indicators as assessment tool to identify peoplefor timely care6. Support a system that gives GP and sp pc community providers proactive involvement in the patient journey (prior to inpatient episode)7. Education that death is not failure (include multi-cultural sensitive careand awareness for any religion/culture)8. Educate community on their involvement in care Patient experience surveys Evaluation framework for rollout of GOPC will indicateprogress11 (11.2) - info/education services toprofessionals and community on pc11 (11.3) - knowledge sharing by sp pc withgeneralists11 (11.4) - pc info and community hotline15 - Educate professionals on right torefuse medical treatment16 - Educate professionals on right torefuse food and water (includes aged care)17 (17.1) - Educate professionals curativeto non-curat
handed down on 23 August 2018 and made 24 recommendations, of which 12 relate to end-of-life and palliative care. Implementation Plan One will address the Strategy implementation in-line with the Outcomes Report, and the 12 JSC recommendations relating to end-of-life and palliative care in tandem. Implementation Plan One also takes into account the
End-of-life milestones Table 1. End-of-Life Milestones and Dates for the Cisco Catalyst 3650 Milestone Definition Date End-of-Life Announcement Date The date the document that announces the end-of-sale and end-of-life of a product is distributed to the general public. October 31, 2020 End-of-Sale Date: HW, Accessory
End-of-life milestones Table 1. End-of-Life Milestones and Dates for the Cisco ASA5525, ASA5545 & ASA5555 Series Security Appliance & 5 YR Subscriptions Milestone Definition Date End-of-Life Announcement Date The date the document that announces the end-of-sale and end-of-life of a product is distributed to the general public. March 6, 2020 End .
End-of-life milestones and dates for the Perpetual Licensing for Cisco Unified Contact Center Express - Replaced by Flex Contact Center Milestone Definition Date End-of-Life Announcement Date The date the document that announces the end-of-sale and end-of-life of a product is distributed to the general public. January 31, 2022 End-of-Sale Date:
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mated number of people in need of end-of-life care is 20.4 million [1]. By 2040, an estimated 75% to 88% of pa-tients at the end-of-life stage could benefit from palliative care [3]. All countries should take heed of the increasing need for end-of-life care [4]. Patients with life-threatening diseases at the end-of-life
Brisbane South PHN 7 END OF LIFE/PALLIATIVE CARE TOOLKIT Chronic Complex Illness Chronic diseases are long lasting, often life-limiting conditions that warrant end-of-life planning. End-of-life planning should occur before conditions progress to later stages where a person's ability to make end-of-life choices may be impeded.
is provided towards the end of life. In this context, 'end of life' can be from the moment someone receives a life-limiting diagnosis, through the months before death, up to and including the inal hours - a continuum rather than a point in time. We use 'end-of-life care' to refer to the care of people with advanced life-
But heaven’s a good place, I’m sure. Life is like nothing other. Life is everything. Life is nothing. Life is out, life is in, life is in-between. Life can be a pain sometimes, Other times, it can be a helper. Life is loved, Life is hated. Life is
