Care homes and end of life care


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A care home 'is' someone's home, one day it could be yours too … best practice in end of life care in care homes. Presentation from Eleanor Sherwen, Elaine Owen and Caroline Flynn from England's National End of Life Care Programme as part of the Department of Health's QIPP end of life care workstream seminar series at Healthcare Innovation Expo 2011

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  • Will need logos here and possible picture to capture the audience’s attention
  • Talking about the picture individuality of us all and we live until we die and we live the way we want and not what people think we should do
  • Public perspective of what they want at EOLC
  • Giving the audience some facts and figures to get then thinking. I have put in some unusual facts to keep their attention
  • Shows the increase in the proportion of the population aged 65 or over . Proportionately the biggest change is in the “very old” – 85 and over PEOPLE AGED 85 and OVER in England In 2006 there were just over a million people living in England aged 85 or over this is expected to rise to over 1.5 million in 2020 And to be 2.3 million in 2030
  • Pre pathway….. Raising awareness
  • Dignity is free. Important to remember this in today's climate. It is the little things that make the difference
  • Relevant quote
  • Outcomes achieved mention QM/M
  • Six steps
  • Care homes and end of life care

    1. 1. Care Homes A care home 'is' someone's home, one day it could be yours too …
    2. 2. A care home 'is' someone's home, one day it could be yours too …
    3. 3. Living well and dying well
    4. 4. Objectives of the presentation <ul><li>Set the context for End of Life Care </li></ul><ul><li>Identify the End of Life Care policy drivers </li></ul><ul><li>Examples of best practice care in care homes </li></ul><ul><li>Demonstrate what people say they want </li></ul><ul><li>Effective engagement with commissioners/providers </li></ul><ul><li>The Six Steps Programme </li></ul><ul><li>Video </li></ul><ul><li>Key messages </li></ul>
    5. 5. Definition of End of Life Care <ul><li>End of life care is simply acknowledged </li></ul><ul><li>to be the provision of supportive and </li></ul><ul><li>palliative care in response to the assessed </li></ul><ul><li>needs of patient and family during the last </li></ul><ul><li>phase of life. </li></ul><ul><li>National Council for Palliative Care(2006) </li></ul>
    6. 6. What do you think constitutes good end of life care? GROUP WORK
    7. 7. What people say is important to them at the end of their life <ul><li>Communication -Being listened to </li></ul><ul><li>Respect </li></ul><ul><li>Dignity, respect and compassion </li></ul><ul><li>Seeing me as a person not a disease </li></ul><ul><li>My wishes respected wherever possible- including place of care </li></ul><ul><li>Remember my family and support network </li></ul><ul><li>My spiritual and religious needs met </li></ul><ul><li>Being symptom free </li></ul>
    8. 8. Where do people die? <ul><li>500,000 people die each year, there is a major discrepancy between people’s preferences for where they should die and their actual place of death </li></ul><ul><ul><li>Most when asked, identify that they would probably like to die at home </li></ul></ul><ul><ul><li>Only around 18% do so with a further 17% in care homes </li></ul></ul><ul><ul><li>Acute hospitals accounting for 58% of all deaths </li></ul></ul><ul><ul><li>Around 4% in hospices </li></ul></ul>
    9. 9. End of Life Care Strategy (DH 2008) <ul><li>1.The challenges of end of life care </li></ul><ul><li>2.Death, dying and society </li></ul><ul><li>3.The end of life care pathway </li></ul><ul><li>4.Care in different settings </li></ul><ul><li>5.Support for carers and families </li></ul><ul><li>6.Workforce </li></ul><ul><li>7.Measurement and research </li></ul>
    10. 10. An ageing population England : The proportion of the total population aged 65 and over Source :Office of National Statistics
    11. 11. <ul><li>The demographic challenge add Graphs Gnomes and Higgingon </li></ul><ul><li>Rising expectations – leading to complaints please add references to NCEPOD and HCC complaints </li></ul><ul><li>Political and public demands for best use of resources </li></ul>The drivers for change Actual and projected deaths England Wales Source : Gomes and Higginson; Where people die (1974–2030): past trends, future projections and implications for care., Palliative Medicine 2008; 22: 33–41
    12. 12. QIPP and the End of Life Care Strategy <ul><li>Taken as a whole, the strategy fits all the QIPP criteria, from quality to prevention: and implementation carries on for all the work people have established </li></ul><ul><li>The EoLC QIPP workstream concentrates on the early part of the pathway: identifying people as they approach the end of life and then planning their care: if we don’t get this right the rest of the strategy has no anchor. </li></ul><ul><li>QIPP will help us to accelerate this strand of the work </li></ul><ul><li>In the meantime, we need to ensure that services are in place to provide the care for patients and their relatives/carers, in the place of their choice. </li></ul>
    13. 13. Patient achieving their wishes and preferences at end of life of where they want to die Reduction in inappropriate hospital admissions Equity and access to end of life care Key Levers for improved Care
    14. 14. What tools are available to support? <ul><li>Gold Standards Framework </li></ul><ul><li>Preferred Priorities of Care </li></ul><ul><li>Liverpool Care Pathway for the dying Patient </li></ul><ul><li>Blended Education; including e-learning, Macmillan foundations training, Routes to Success and Six Step programme </li></ul>
    15. 15. Support for Implementation
    16. 16. Death, dying and society <ul><li>National Coalition – Dying Matters </li></ul><ul><li>Over 14,000 members </li></ul><ul><li>First Awareness Week March 2010- </li></ul><ul><li>Second planned w/c16 May 2011 </li></ul><ul><li>Materials available on website </li></ul><ul><li> </li></ul><ul><li> </li></ul>
    17. 18. Examples of best practice: Education & Training <ul><li>Implementing a 6 month support and training programme in care homes in Avon, Gloucestershire and Wiltshire NHS South West </li></ul><ul><li>Involved 12 care homes </li></ul><ul><li>Joint training programmes can help to combat the sense of isolation among many care home staff </li></ul><ul><li>A combination of education and mentoring can have a big impact </li></ul>
    18. 19. Example of best practice: Liaison and Support to care homes <ul><li>A scheme to support and advise care home staff in Warrington has cut hospital admissions and given residents greater choice about where they die. </li></ul><ul><li>Between April 2009 and March 2010, the number of A&E attendances from care homes in Warrington has dropped by 250, emergency admissions have fallen by 288 and a total of 8,836 hospital bed days have been saved. </li></ul>
    19. 20. Example of best practice: LCP in care homes <ul><li>Northamptonshire NHS Provider Services have developed a step approach to LCP implementation in care homes </li></ul><ul><li>The process involves training beforehand, ongoing support once the LCP is being used and participation in the LCP Reflective Data Cycle </li></ul><ul><li>Seventy per cent of those who died in care homes registered with the project had their care guided by the LCP. </li></ul>
    20. 21. Examples of best practice: Enabling individuals to remain in their home <ul><li>Improved liaison with primary care trust services is enabling patients with Huntington’s disease in Strood, Kent to remain in care homes (personal care) until they die </li></ul><ul><li>Regular meetings held with dieticians, speech and language therapists, Palliative care critical nurse specialists. </li></ul><ul><li>Regular patient reviews with GPs and palliative medical consultants </li></ul>
    21. 22. <ul><li>“ It should not be down to ’luck’ and where we live in the country as to how we die, we all know death happens and we should be more prepared, human and caring” </li></ul><ul><li>Comment posted on the Patient Opinion </li></ul><ul><li>website </li></ul>
    22. 23. <ul><li>How do we ensure there is effective engagement between commissioners, care home providers? </li></ul><ul><li>GROUP WORK </li></ul>
    23. 24. How will the resident & family/commissioner/care home know it has worked <ul><li>Residents receive their wishes and preferences at end of life </li></ul><ul><li>Family feel supported </li></ul><ul><li>Use of Liverpool Care pathway/Six Steps to Success programme demonstrates quality care given </li></ul><ul><li>Staff are trained and competent to deliver the care </li></ul><ul><li>Fewer complaints </li></ul><ul><li>Reduction in inappropriate hospital admissions </li></ul><ul><li>Equity and equal access to quality end of life care to all </li></ul>
    24. 28. Why? <ul><li>Fits with the End of Life Care Strategy identifying the need for a cultural shift in attitude & behaviour across the health & social care workforce towards end of life care </li></ul><ul><li>10% reduction in inappropriate hospital deaths ( North West Healthier Horizons 2008) </li></ul><ul><li>Provide stronger partnerships between the NHS and the independent care sector </li></ul><ul><li>Address the key components of End of Life Care education to support care homes in providing end of life care i.e. Advance Care Planning, communication skills & Liverpool Care Pathway </li></ul><ul><li>Improving equity of quality end of life care for all residents in a care home. </li></ul><ul><li>Delivery of quality end of life care in care homes requires an effective balance of external support and internal resources. </li></ul>
    25. 29. QIPP Quality <ul><li>Improve the resident and family experience of end of life care in a care home setting </li></ul><ul><li>Enhance care delivery within the care home at end of life </li></ul><ul><li>A skilled workforce </li></ul>Innovation <ul><li>A low cost Network EOL programme providing a consistent approach across PCT’s with a wide access to all care homes </li></ul><ul><li>Can support care homes who currently have high recorded admissions to the acute sector for end of life care </li></ul><ul><li>Develop a care home representative to take responsibility for the future development of end of life care provision in their care home </li></ul>Productivity <ul><li>Enhanced end of life care </li></ul><ul><li>Enhanced MDT working </li></ul><ul><li>Deliver choice at end of life </li></ul><ul><li>Wider awareness and implementation of End of life care </li></ul><ul><li>Development of PCT End of Life Care home representative Groups </li></ul><ul><li>Address equity </li></ul>Prevention <ul><li>Reduction in hospital admissions at end of life from Care homes </li></ul><ul><li>Reduction of isolated working </li></ul>
    26. 30. The Future <ul><li>‘ more work is needed to enable integration of nursing homes into the wider systems of end of life care and to enable collaboration across organizational, institutional and funding boundaries so that patients receive a better quality of end of life care regardless of the care setting in which they are located’. </li></ul><ul><li>Jane E Seymour, Arun Kumar and Katherine Froggatt (2009) </li></ul>
    27. 31. My Home Life Video <ul><li>Supporting good end of life care video </li></ul><ul><li>Reference: </li></ul><ul><li> </li></ul>
    28. 32. “ You matter because you are you. You matter to the last moment of your life and we will do all we can, not only to help you die peacefully, but to live until you die.” Dame Cicely Saunders
    29. 33. References <ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul>
    30. 34. Contact us: <ul><li>Website www.endoflifecareforadults.nhs.u </li></ul><ul><li>Email [email_address] </li></ul><ul><li>Telephone 0116 222 5103 </li></ul><ul><li>National End of Life Care Intelligence Network </li></ul><ul><li> </li></ul>