Improving care at home for people with frailty

People with palliative care needs should be able to choose where they receive care. Hospice staff are skilled at helping people think about where they want to spend the end of their lives, and respecting their wishes as much as possible.

If someone living with frailty is not receiving the care they need, their condition can escalate and this might result in an emergency. Once a patient has been admitted to hospital, their frailty might make it more difficult for them to be discharged. This can be particularly distressing if the hospital is not the person's preferred place of care.

By improving care for people in their homes, hospices can help make sure the needs of patients with frailty are addressed as early as possible. This can help prevent incidents happening and reduce hospital visits.

Domiciliary carers might be the first line of contact for people living with frailty. They have regular contact with patients in their homes, and have a unique understanding of their needs.

By providing domiciliary carers with specialised training, hospices can empower them to recognise the signs of frailty and refer patients on to specialist support services.

St Clare Hospice in Essex engaged four domiciliary care agencies to deliver a six-month training programme to their carers. The project aimed to give carers the skills to diagnose, assess and provide care to patients with frailty. It also made sure carers knew when and how to seek a referral.

In-person training sessions at the hospice covered core concepts such as:

• using the Rockwood scale to assess someone's level of frailty
• understanding the key components of palliative care
• recognising when a patient is at the end of life
• an introduction to advance care planning
• sources of support such as St Clare Hospice’s 24 hour advice line.

Through the project, domiciliary carers who have formed long-term relationships with patients were also offered bereavement support.

The project was successful, with 83% of the carers who took part reporting that they would change their practice as a result of the training. 

The virtual ward is a valuable tool to support patients who wish to be cared for in their own homes.

Virtual wards combine face-to-face visits and remote monitoring technology such video calling tools and wearable devices. This enables patients to receive expert clinical care while remaining at home. 

Virtual wards can also enable earlier identification of frailty, which can then be monitored during daily patient reviews.

Prospect Hospice in Swindon used the virtual ward as a “capture” point, to identify patients with frailty and take the opportunity to carry out advance care planning. The hospice’s virtual ward team now sees five patients per week, 80% of whom are new to the hospice and did not previously have an advance care plan in place.