Helping care home staff to support residents with frailty

Hospices can liaise with care homes to share skills and support residents living with frailty. This could include:

• creating plans for incidents like falls
• advising on medication
• advice on managing incidents
• making sure residents’ wishes are followed.

This can give staff the confidence to care for residents should an incident happen and prevent unneccesary hospital admissions, which can cause distress to the patient.

Having a point of contact for guidance when complex situations arise can be hugely beneficial for care home staff when they are unsure of the best options for residents, particularly in an emergency situation. 

Highland Hospice in Scotland received feedback from care home staff that they felt confused about when residents needed urgent medical care. In response, they set up a 24/7 telephone helpline.

The Palliative Care Helpline provides advice on pain management and medication, as well the process of verifying a death. Its objective is to reduce calls from care home staff to emergency services and unplanned admissions to hospital, which tend to increase for people in their last year of life. Care home staff have reported using this service multiple times instead of calling 999.

The helpline is also available to Scottish Ambulance Service staff when they attend to care home residents. This is especially valuable during out-of-hours periods when other support is difficult to access. It enables ambulance staff to provide person-centred care and direct the care home to the most appropriate form of treatment.

Care home staff may not receive formal training in managing the unique needs of people living with frailty, particularly when these needs overlap with palliative care.

Hospices can facilitate training that covers:

• how to assess levels of frailty
• risk factors
• frailty trajectories
• mental and emotional health
• engaging in conversations around future care planning.

St Christopher’s Hospice in London set up a training programme for care staff. This gave them a better understanding of frailty, greater awareness of the support the hospice offers and other useful services in the community. Their programme included informal sessions on rehabilitation, decision-making and deprescribing.

Care home staff who attended the sessions reported becoming more engaged in advance care planning. They had an increased focus on rehabilitation goals like diet changes.

People with frailty in care homes can benefit from physiotherapy and occupational therapy to maintain their wellbeing and help them retain a sense of independence.

This can take the form of visits from the therapists, or as in the case of ellenor in Kent, running exercise classes for care home residents. These seated sessions were designed to improve strength and mobility, and reduce the risk of falls.

As well as improving the residents’ wellbeing, care home staff said they are now more aware of how frailty can be addressed with support from the hospice. After successfully piloting this project, ellenor is aiming to continue offering it as a package for care homes in its catchment area.