Caroline Flynn, Elaine Horgan and Christine Taylor
Concept
To develop a low cost, consistent end of life care
programme, available to all care homes.
It will support the development of nominated staff in
residential and nursing homes to become End of Life Care
Home Representatives (champions) implementing
organisational change utilising the Route to Success for
care homes.
Why?
• Fits with the End of Life Care Strategy, identifying the
need for a cultural shift in attitude and behaviour across
the health and social care workforce
• 10% reduction in inappropriate hospital deaths
(North West Healthier Horizons 2008)
• Provide stronger partnerships between the NHS and the
independent care sector
• Address the key components of End of Life Care
education to support care homes in providing end of life
care i.e. ACP, communication skills and LCP
• Improving equity of quality end of life care for all
residents in a care home
End of Life Care Strategy
2008
4.39
“Good PCTs working with local authorities will wish to
commission services from care homes which:
• Residents approaching the end of life are on an end of life care
register
• Each resident is offered a care plan, which clearly identifies their
needs and preferences for care
• Staff receive the training and support they need to provide end of life
care
• There is a appropriate access to GP, District nursing and specialist
palliative care advice”
DOH, 2008, End of Life Care Strategy p95
QIPP
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Quality
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Innovation
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Improve the resident and family experience of end of life care in a
care home setting
Enhance care delivery within the care home at end of life
A skilled workforce
A low cost Network EOL programme providing a consistent approach
across PCTs with a wide access to all care homes
Can support care homes who currently have high recorded
admissions to the acute sector for end of life care
Develop a care home representative to take responsibility for the
future development of end of life care provision in their care home
Productivity
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Enhanced end of life care
Enhanced MDT working
Deliver choice at end of life
Wider awareness and implementation of End of life care
Development of PCT End of Life Care home representative Groups
Address equity
Prevention
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Reduction in hospital admissions at end of life from Care homes
Reduction of isolated working
CQC
CQC (2010)
End of Life Care Prompts Care Homes: Guidance for
Inspectors
How should a care home that provides end of life care
support the person?
CQC questions to consider…
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Do staff have knowledge & skills to identify EoLC needs? A relevant care assessment
is in place
Systems in place to access relevant members of PHCT
Needs assessment reviewing, pain, tissue viability, nutritional needs etc.
Are residents and loved ones included in the decision making process?
Are residents given the opportunity to discuss PPC?
Is there a policy and training for staff with clear records if a DNAR is recorded?
Do the staff use a pain chart?
Do documents used support end of life planning e.g. LCP?
The least possible disruption to the individual and their family and those close to them
(see CQC Guidance for inspectors)
End of Life Care Quality
Markers For Care Homes
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Action Plan for EOL
Mechanisms to discuss and record wishes (ACP)
Resident’s needs assessed and reviewed
Nominate a key worker for each resident at EOL
Residents who are dying are entered onto a care pathway
Families and carers are involved in decisions at EOL to the extent they wish
Other Residents are supported following a death
Quality of EOL care is audited and reviewed
Process to identify training needs of all workers, common requirements –
communication skills, assessment and care planning, ACP and symptom
management
Training needs addressed for those staff initiating ACP
Aware and encourage attendance to EOL care training
Review all transfers in and out of the care home at EOL
End of Life Care Training
Matrix
Gold Standards
Framework
All care homes to
access End of
Life Care training
Macmillan
Foundations in
Palliative Care
Pack /TRIBAL
Six Steps to
Success
Other Education
Programmes
Overview of the Six Steps
to Success Programme
• Induction workshop
• Six Steps to Success workshops
• Supporting education: communication skills, Advance
Care Planning and Liverpool Care Pathway for the dying
patient (LCP)
• Conclusion workshop
• Continuation of care home forum
Recruitment
• Local awareness raising session
• Participation agreement to be signed
• Registration
Expectations of an End of
Life Care Home Representative
• Regularly meet with other End of Life Care Home
Representatives
• Develop other learners in end of life care
• Build resource files within the care home
• Produce a portfolio to evidence the implementation of
the programme that could be shared with regulatory
bodies (CQC), commissioners and social services
• To be a link with the local End of Life Care Facilitator
• Initiate change management within the home
Induction Workshop
• Attendance from care home representative and
manager/matron
• Portfolio of evidence
• Completion of knowledge, skills and confidence audit
• Pre programme audit on end of life care activity
• National, regional and local driving forces
• Introduction to the Six Steps to Success programme
• Audit cycle/change management
• Roles and responsibilities of care home representative
• Commence an end of life care policy/action plan
Six Steps
Step 1 - Discussions as the end of life approaches
Step 2 - Assessment, care planning and review
Step 3 - Co-ordination of care
Step 4 - Delivery of high quality care in care homes
Step 5 - Care in the last days of life
Step 6 - Care after death
Conclusion Workshop
• Review of the programme
• Individual feedback on progress
• Portfolio review
• Issues and challenges
• Post programme audit
• Completion of End of Life Care Policy
Celebration
• On Completion of the six step programme the End of Life
Care Representative will become the Care Home End of
Life Care ‘Champion’
• The Care Home Representative will receive a certificate
of attendance
• Care home will receive a dated certificate on completion
of portfolio
Sustainability
• Care home forum continues regularly
• External speakers
• Staff agendas
• Continuing access to education and support
End of Life Care Home Forum will be a valuable resource
group to drive and trial new initiatives in End of Life Care
for the care home sector i.e. e –learning
Evaluation
• Ongoing evaluation throughout the course
• Pre and post-course audits
• Audit of ACP and LCP
• National roll out of the Six Steps to Success Programme
Recruitment Presentation V1 07092011