Compton Care worked with its local Integrated Care Board (ICB) and Macmillan Cancer Support on a three month project to complete ReSPECT advance care planning forms in local nursing homes. The aim of the project was to help ensure each patient’s wishes about their care and treatment in the future were recorded accurately.
It soon became clear there was a strong need for longer term palliative care support in the local nursing, residential and learning disability homes.
Outcomes
The hospice developed a palliative care service for residential homes. The six-person team is made up of Clinical Nurse Specialists (CNS), palliative care specialists and paramedics.
The team have continued to have discussions around ReSPECT and Advance Care Planning with patients in residential homes. They also support care home staff to care for patients with complex symptoms. This includes:
talking through treatment plans
helping staff refresh and practice key skills (such as using syringe drivers)
holding regular Q&A drop-in sessions.
By helping staff feel more confident about caring for patients at the end of life, the team has reduced unnecessary admissions to hospital.
The Compton team supports care home staff when patients die, by holding a ‘debrief’ session. Here, staff are able to discuss what happened, ask questions and acknowledge their own grief.
Facilitators, challenges and advice
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Key facilitators
The initial three month project was endorsed by the ICB, and this provided strong evidence about the need to continue the service.
Care home residents have begun to tell each other about ReSPECT forms, and recommend that their friends talk to a member of the hospice team. The hospice team have protected time for ReSPECT work, so they are able to spend as much time with patients as needed. This is a really important part of building trust and making sure each individual’s wishes are heard.
Challenges
Staff in the care homes were understandably suspicious of the service to start with. Providing overnight support has been particularly challenging as care homes often employ agency staff at night who are not always aware of the hospice service.
To overcome this, the hospice team has worked hard to build up relationships with care home staff. This includes:
allocating one member of Compton staff to each Primary Care Network in the area, to make sure care homes consistently work with the same person
putting posters in care homes, local GP surgeries etc about the service with a photo of the key member of staff
allocating a set day where the member of staff will be at each care home.
When patients have dementia or learning disabilities, it can be quite complicated to assess their capacity and work with their families to put a plan in place. The hospice team are specially trained to do this.
ICB funding for the service stopped after the initial 3 months, so Compton now funds the whole service. At the moment, the service is only available in Wolverhampton (which is only part of the hospice’s footprint).
Tips and advice
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You are there to support, not take over. Remember that care homes are private businesses with their own governance.
Think about what care homes need from you, rather than what you want to do.
Be consistent – if you are running a regular Q&A or debrief session and nobody turns up, don’t be discouraged! Keep going and numbers will improve.
Dying isn’t always the most frightening thing for someone in a care home – it is being reliant on strangers for care. It’s really important to acknowledge this and give people space to make their wishes heard.
Future development
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The hospice is developing a training programme for GPs and care homes about topics such as talking to bereaved families and verification of death. Some of these are online resources, which can be accessed at any time.
The team’s CNS nurse prescriber has begun working with local care homes to plan ahead for weekends and bank holidays, ensuring they have enough anticipatory medication in stock to cover periods when it is difficult to get prescriptions.
