34 Specialist palliative care providers’ perspectives on how to meet the service delivery challenges in adult care homes in england: a national survey

2018 ◽  
Vol 8 (3) ◽  
pp. 372.2-373
Author(s):  
Alisha Newman ◽  
Gemma Allnatt ◽  
Nicola Bowtell ◽  
Kerry Archer-Dutton ◽  
Anita Hayes ◽  
...  
Keyword(s):  
Public Health ◽  
Palliative Care ◽  
End Of Life ◽  
Health Research ◽  
Core Competencies ◽  
Care Home ◽  
Care Homes ◽  
List Type ◽  
Specialist Palliative Care ◽  
Provider Perspective

IntroductionCare homes (CHs) play a vital role in the delivery of care towards the end of life (National Institute for Health Research 2017; Public Health England 2017) yet little is known about specialist palliative care (SPC) support in this setting.AimTo increase understanding of how SPC services support adult CHs in England and identify from a SPC provider perspective the challenges and enablers to good quality SPC.MethodSPC services working directly with CHs in the community in England were invited to complete an online survey. Content analysis enabled qualitative data to be described.Results108 services participated. A range of challenges were identified including CH staff turnover lack of funding and retention of CH staff knowledge skills and competency.Proposed ways to reduce/resolve challenges included:Increased commissioning of SPC staff to work directly with CHs particularly to provide education/trainingStrategic centralised and longer–term approaches to funding to facilitate continuity of support to CHsMandatory SPC core competencies and accessible training for CH staff to facilitate the prioritisation and uptake of trainingIncreased collaboration within and across organisations including regulators commissioners and providers of SPC CH and GP services to increase consistency and quality of SPC education and resident careConclusionsThe data are of national relevance and enhances our understanding of the challenges and potential enablers to CH support from a SPC provider perspective. Increased funding and cross-organisational collaboration are thought to be important instruments for change. The views of others including CH staff should be sought.References. National Institute for Health Research. Advancing care – Research with care homes 2017. Available at: https://www.dc.nihr.ac.uk/themed-reviews/care-home-research.htm [Accessed: 29th May 2018]. Public Health England. Briefing 1 – Care home bed provision and potential end of life care need in people aged 75 or older in England2017. Available at: http://www.endoflifecareintelligence.org.uk/resources/publications/carehomes [Accessed: 29th May 2018]

scholarly journals Reducing time in acute hospitals: A stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes

2020 ◽  
Vol 34 (5) ◽  
pp. 571-579 ◽  
Author(s):  
Liz Forbat ◽  
Wai-Man Liu ◽  
Jane Koerner ◽  
Lawrence Lam ◽  
Juliane Samara ◽  
...  
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Care Home ◽  
Care Homes ◽  
Randomised Control Trial ◽  
Specialist Palliative Care ◽  
Stepped Wedge ◽  
Model Of Care ◽  
Care Needs ◽  
Palliative Care Needs

Background: Care home residents are frequently transferred to hospital, rather than provided with appropriate and timely specialist care in the care home. Aim: To determine whether a model of care providing specialist palliative care in care homes, called Specialist Palliative Care Needs Rounds, could reduce length of stay in hospital. Design: Stepped-wedge randomised control trial. The primary outcome was length of stay in acute care (over 24-h duration), with secondary outcomes being the number and cost of hospitalisations. Care homes were randomly assigned to cross over from control to intervention using a random number generator; masking was not possible due to the nature of the intervention. Analyses were by intention to treat. The trial was registered with ANZCTR: ACTRN12617000080325. Data were collected between 1 February 2017 and 30 June 2018. Setting/participants: 1700 residents in 12 Australian care homes for older people. Results: Specialist Palliative Care Needs Rounds led to reduced length of stay in hospital (unadjusted difference: 0.5 days; adjusted difference: 0.22 days with 95% confidence interval: −0.44, −0.01 and p = 0.038). The intervention also provided a clinically significant reduction in the number of hospitalisations by 23%, from 5.6 to 4.3 per facility-month. A conservative estimate of annual net cost-saving from reduced admissions was A$1,759,011 (US$1.3 m; UK£0.98 m). Conclusion: The model of care significantly reduces hospitalisations through provision of outreach by specialist palliative care clinicians. The data offer substantial evidence for Specialist Palliative Care Needs Rounds to reduce hospitalisations in older people approaching end of life, living in care homes.

scholarly journals Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e049486
Author(s):  
Aisha Macgregor ◽  
Alasdair Rutherford ◽  
Brendan McCormack ◽  
Jo Hockley ◽  
Margaret Ogden ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Home ◽  
Care Homes ◽  
Successful Implementation ◽  
Life Care ◽  
Care Home Staff ◽  
Palliative Care Teams ◽  
The Uk

IntroductionPalliative and end-of-life care in care homes is often inadequate, despite high morbidity and mortality. Residents can experience uncontrolled symptoms, poor quality deaths and avoidable hospitalisations. Care home staff can feel unsupported to look after residents at the end of life. Approaches for improving end-of-life care are often education-focused, do not triage residents and rarely integrate clinical care. This study will adapt an evidence-based approach from Australia for the UK context called ‘Palliative Care Needs Rounds’ (Needs Rounds). Needs Rounds combine triaging, anticipatory person-centred planning, case-based education and case-conferencing; the Australian studies found that Needs Rounds reduce length of stay in hospital, and improve dying in preferred place of care, and symptoms at the end of life.Methods and analysisThis implementation science study will codesign and implement a scalable UK model of Needs Rounds. The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to identify contextual barriers and use facilitation to enable successful implementation. Six palliative care teams, working with 4–6 care homes each, will engage in two phases. In phase 1 (February 2021), stakeholder interviews (n=40) will be used to develop a programme theory to meet the primary outcome of identifying what works, for whom in what circumstances for UK Needs Rounds. Subsequently a workshop to codesign UK Needs Rounds will be run. Phase 2 (July 2021) will implement the UK model for a year. Prospective data collection will focus on secondary outcomes regarding hospitalisations, residents’ quality of death and care home staff capability of adopting a palliative approach.Ethics and disseminationFrenchay Research Ethics Committee (287447) approved the study. Findings will be disseminated to policy-makers, care home/palliative care practitioners, residents/relatives and academic audiences. An implementation package will be developed for practitioners to provide the tools and resources required to adopt UK Needs Rounds.Registration detailsRegistration details: ISRCTN15863801.

scholarly journals Changing patterns of mortality during the COVID-19 pandemic: population-based modelling to understand palliative care implications

2020 ◽  
Author(s):  
Anna E Bone ◽  
Anne M Finucane ◽  
Javiera Leniz ◽  
Irene J Higginson ◽  
Katherine E Sleeman
Keyword(s):  
Palliative Care ◽  
High Mortality ◽  
Care Home ◽  
Healthcare Systems ◽  
Population Based ◽  
Care Homes ◽  
List Type ◽  
Integrated Models ◽  
Care Needs ◽  
England And Wales

AbstractBackgroundCOVID-19 has directly and indirectly caused high mortality worldwide.AimTo explore patterns of mortality during the COVID-19 pandemic and implications for palliative care provision, planning, and research.DesignDescriptive analysis and population-based modelling of routine data.Participants and settingAll deaths registered in England and Wales between 7th March and 15th May 2020. We described the following mortality categories by age, gender and place of death: 1) baseline deaths (deaths that would typically occur in a given period) 2) COVID-19 deaths 3) additional deaths not directly attributed to COVID-19. We estimated the proportion of COVID-19 deaths among people who would be in their last year of life in the absence of the pandemic, using simple modelling with explicit assumptions.ResultsDuring the first 10 weeks of the pandemic there were 101,615 baseline deaths, 41,105 COVID-19 deaths and 14,520 additional deaths. Deaths in care homes increased by 220% compared to home and hospital deaths which increased by 77% and 90%. Hospice deaths fell by 20%. Additional deaths were among older people (86% aged ≥75 years), and most occurred in care homes (56%) and at home (43%). We estimate that 44% (38% to 50%) of COVID-19 deaths occurred among people who would have been in their last year of life in the absence of the pandemic.ConclusionsHealthcare systems must ensure availability of palliative care to support people with severe COVID-19 in community and hospital settings. Integrated models of palliative care in care homes are urgently needed.Key statementsWhat is already known about the topic?The COVID-19 pandemic has directly and indirectly resulted in high mortality in many affected nations.Internationally the response has been focused on prevention and curative treatments, with little emphasis on palliative care needs of people dying during the COVID-19 pandemic.We do not know how many of those dying with COVID-19 would have been in their last year of life in the absence of the pandemic, and this group may have distinct care needs.What this paper addsThe number of people dying in care homes trebled during the first 10 weeks of the COVID-19 pandemic in England and Wales; many of these deaths were ‘additional deaths’, that is associated with the COVID-19 pandemic but not directly as a result of COVID-19.We estimate almost half of all COVID-19 deaths occurred among people who would have been in their last year of life in the absence of the pandemic.Implications for practice, theory or policyHealthcare systems must ensure availability of palliative care to support people with severe COVID-19 in community and hospital settings.The need for integrated models of palliative care in care home settings is imperative and research to underpin these models is warranted.

scholarly journals A qualitative comparison of care home staff and palliative care specialists’ experiences of providing end of life care to people living and dying with dementia in care homes in two countries: A focus group study

2021 ◽  
pp. 026921632110433
Author(s):  
Melanie Handley ◽  
Deborah Parker ◽  
Frances Bunn ◽  
Claire Goodman
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Home ◽  
Care Homes ◽  
Life Care ◽  
Term Care ◽  
Sustainable Solutions ◽  
Care Home Staff ◽  
People With Dementia

Background: Palliative care for people with dementia dying in care homes is an important aspect of long-term care. Whilst there is consensus about the principles of palliative care, less is known about how care home staff negotiate and influence decisions around end of life and how organisational context shapes that process. Aim: To explore the views and experiences of care home staff and palliative care specialists on end of life care in care homes and understand how care home settings affected palliative care provision in England and Australia. Design/participants: Eight focus groups in Australia and England with care home staff and palliative care specialists ( n = 49). Reflexive thematic analysis was undertaken. Findings: Australian participants reported collaboration between care home staff, visiting professions and family members though case conferences. English participants discussed resident-focussed involvement from specialists that was less formally organised. Negotiating roles and responsibilities in end of life care; the importance of relationships to overcome deficiencies in formal processes; and the legitimacy and authority of advance care planning at times of crisis were recurring themes. The organisation and embedding of end of life care in processes and practices of care homes differed; this closely linked to care home procedures in Australia but was less apparent in England. Conclusion: In both countries, partnership working was recognised and valued as key to effective palliative care. Work that enables care home staff to identify challenges with visiting professionals, such as agreeing priorities for care and negotiating their shared responsibilities, may lead to context-sensitive, sustainable solutions.

scholarly journals Winners and Losers in Palliative Care Service Delivery: Time for a Public Health Approach to Palliative and End of Life Care

Healthcare ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1615
Author(s):  
Samar M. Aoun     ◽  
Robyn Richmond ◽  
Leanne Jiang ◽  
Bruce Rumbold
Keyword(s):  
Public Health ◽  
Palliative Care ◽  
End Of Life ◽  
Cancer Diagnosis ◽  
End Of Life Care ◽  
Palliative Care Service ◽  
Community Services ◽  
Public Health Approach ◽  
Life Care ◽  
Specialist Palliative Care

Background: Consumer experience of palliative care has been inconsistently and selectively investigated. Methods: People in Western Australia who had experienced a life limiting illness in the past five years were recruited via social media and care organisations (2020) and invited to complete a cross sectional consumer survey on their experiences of the care they received. Results: 353 bereaved carers, current carers and patients responded. The winners, those who received the best quality end-of-life care, were those who were aware of palliative care as an end-of-life care (EOLC) option, qualified for admission to and were able to access a specialist palliative care program, and with mainly a cancer diagnosis. The losers, those who received end-of-life care that was adequate rather than best practice, were those who were unaware of palliative care as an EOLC option or did not qualify for or were unable to access specialist palliative care and had mainly a non-cancer diagnosis. Both groups were well supported throughout their illness by family and a wider social network. However, their family carers were not adequately supported by health services during caregiving and bereavement. Conclusions: A public health approach to palliative and end of life care is proposed to integrate tertiary, primary, and community services through active consumer engagement in the design and delivery of care. Therefore, suggested strategies may also have relevance in many other international settings.

scholarly journals 77 National Audit of Care At the End of Life (NACEL)—Round Two Findings

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
D Hibbert
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Service ◽  
Palliative Care Service ◽  
Care Plan ◽  
Specialist Palliative Care ◽  
Experience Of Care ◽  
Outcomes Of Care ◽  
Specialist Palliative Care Service ◽  
The Right

Abstract   NACEL is a national comparative audit of the quality and outcomes of care experienced by the dying person and those important to them during the final admission in acute and community hospitals in England and Wales. Mental health inpatient providers participated in the first round but excluded from the second round. NACEL round two, undertaken during 2019/20, comprised: Data was collected between June and October 2019. 175 trusts in England and 8 Welsh organisations took part in at least one element of NACEL (97% of eligible organisations). Key findings include Recognising the possibility of imminent death: The possibility that the patient may die was documented in 88% of cases. The median time from recognition of dying to death was 41 hours (36 hours in the first round). Individual plan of care: 71% of patients, where it had been recognised that the patient was dying (Category 1 deaths), had an individualised end of life care plan. Of the patients who did not have an individualised plan of care, in 45% of these cases, the time from recognition of dying to death was more than 24 hours. Families’ and others’ experience of care: 80% of Quality Survey respondents rated the quality of care delivered to the patient as outstanding/excellent/good and 75% rated the care provided to families/others as outstanding/excellent/good. However, one-fifth of responses reported that the families’/others’ needs were not asked about. Individual plan of care: 80% of Quality Survey respondents believed that hospital was the “right” place to die; however, 20% reported there was a lack of peace and privacy. Workforce Most hospitals (99%) have access to a specialist palliative care service. 36% of hospitals have a face-to-face specialist palliative care service (doctor and/or nurse) available 8 hours a day, 7 days a week. NACEL round three will start in 2021.

scholarly journals Examining public knowledge, attitudes and perceptions towards palliative care: a mixed method sequential study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sonja McIlfatrick ◽  
Paul Slater ◽  
Esther Beck ◽  
Olufikayo Bamidele ◽  
Sharon McCloskey ◽  
...  
Keyword(s):  
Public Health ◽  
Palliative Care ◽  
End Of Life ◽  
Current Knowledge ◽  
Care Delivery ◽  
Public Awareness ◽  
Public Understanding ◽  
Public Health Issue ◽  
Public Health Approach ◽  
Cross Sectional Survey

Abstract Background Palliative care is recognised as a public health issue with the need for earlier integration in the wider healthcare system. However, research indicates that it continues to be accessed late in the course of an illness, public understanding of palliative care is limited, and common misconceptions prevail. Strategies to address this are needed in order to reduce barriers to palliative care delivery and improve access. Methods An explanatory sequential mixed methods study, comprising a cross-sectional survey and interviews was undertaken. Sociodemographic characteristics, public awareness, knowledge and perceptions of palliative care were examined and strategies to raise awareness and overcome barriers within a public health framework were identified. Survey data were analysed using SPSS v25 with factor analysis and non-parametric statistics and qualitative data were analysed using thematic analysis. Results A total of 1201 participants completed the survey (58.3% female, mean age 61 years) and 25 took part in interviews. A fifth of participants (20.1%) had previously heard about palliative care and had an accurate understanding of the term. Being female, higher educated, married, and older, increased respondents’ levels of awareness. The three most commonly held misconceptions included: Palliative care is exclusively for people who are in the last 6 months of life (55.4% answered incorrectly); A goal of palliative care is to address any psychological issues brought up by serious illness (42.2% answered incorrectly); and a goal of palliative care is to improve a person’s ability to participate in daily activities (39.6% answered incorrectly). Talking about palliative and end of life care was advocated but societal taboos restricted this occurring with exposure limited to personal experience. Conclusions Current knowledge gaps and misconceptions derived from limited ad hoc personal experiences and fear of engaging in taboo conversations may deter people from accessing integrated palliative care services early in a disease trajectory. The results indicate the need for public education programmes that move beyond merely raising awareness but provide key messages within a public health approach, which may change attitudes to palliative care thus ultimately improving end of life outcomes.

scholarly journals Key Components for the Delivery of Palliative and End-of-Life Care in Care Homes in Hong Kong: A Modified Delphi Study

2022 ◽  
Vol 19 (2) ◽  
pp. 667
Author(s):  
Helen Yue-Lai Chan ◽  
Cecilia Nim-Chee Chan ◽  
Chui-Wah Man ◽  
Alice Dik-Wah Chiu ◽  
Faith Chun-Fong Liu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hong Kong ◽  
End Of Life ◽  
Delphi Study ◽  
End Of Life Care ◽  
Care Home ◽  
Local Context ◽  
Life Care ◽  
Home Setting ◽  
Modified Delphi

Integrating the palliative care approach into care home service to address the complex care needs of older adults with frailty or advanced diseases has been increasingly recognized. However, such a service is underdeveloped in Hong Kong owing to socio-cultural and legal concerns. We adopted a modified Delphi study design to identify the key components for the delivery of palliative and end-of-life care in care home settings for the local context. It was an iterative staged method to assimilate views of experts in aged care, palliative care, and care home management. A multidisciplinary expert panel of 18 members consented to participate in the study. They rated their level of agreement with 61 candidate statements identified through a scoping review in two rounds of anonymous surveys. The steering group revised the statements in light of the survey findings. Eventually, the finalized list included 28 key statements concerning structure and process of care in seven domains, namely policy and infrastructure, education, assessment, symptom management, communication, care for dying patients, and family support. The findings of this study underscored concerns regarding the feasibility of statements devised at different levels of palliative care development. This list would be instrumental for regions where the development of palliative and end-of-life care services in care home setting is at an initial stage.

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