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‘Made to fit’: filling critical gaps with a hospice at home service
  1. Catherine Baldry1,
  2. Barbara Jack2,
  3. Karen Groves1,
  4. Kathryn Gaunt3,
  5. Janice Sephton1 and
  6. Alison Whelan2
  1. 1Queenscourt Hospice, Southport, UK
  2. 2Edge Hill University, Ormskirk, UK
  3. 3Mersey Deanery, Liverpool, UK

Abstract

Background Promoting the choice to die at home is central to UK policies and strategies. Nationally, various models of Hospice at Home service support this choice. Locally a service was developed to fill gaps in, and work together with, existing community services providing a bespoke Hospice at Home Service outreaching from the hospice hub.

Method Retrospective cohort study and stakeholder evaluation during a 1 year pilot study in the North West of England. Data (demographic and service intervention) was collected on 201 service recipients. 55 Healthcare Professionals; (General Practitioners, District Nurses, Community Specialist Palliative Care Nurses and Hospital Discharge Coordinator) participated in semi-structured interviews, focus groups and electronic open end questionnaires.

Results In the first year, 201 received the service. 184 (92%) had cancer, 36% aged over 80 years. 57 (28%) lived alone. 181 (90%) recipients died. 73% (132) died at home (72% (120) with cancer), 6% (29) in the hospice, 12 (6.5%) care home, 1 (0.5%) in an ambulance on their way home, 7 (4%) hospital. 51 patients lived alone, 69% (35) died at home. Healthcare Professionals reported the impact of the different elements of the service (accompanied transfer home; multiprofessional (including doctors) crisis intervention team and a flexible sitting service) as being instrumental in helping patients to remain at home. The additional service supplements existing services, enables a speedier discharge home and supports carers to enable them to continue coping. It is of interest that in the second year a 73% home death rate has been maintained.

Conclusions This novel bespoke service provides different elements of a Hospice at Home service, a tailor made package to meet individual and local area needs. This service appears to be having a major impact on place of death and is enabling patients to die in their place of choice

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