Aims To evaluate the impact of changes in community care provision on admissions to a hospice inpatient unit.
Background Consistent with UK population demographic changes, increasing numbers of palliative care patients are elderly and frail, often with multiple co-morbidities, and frequently living alone and geographically isolated from traditional family units. Local government funding cuts are impacting on the necessary growth in adult social care spending to meet rising demand, and efficiency savings have resulted in fewer community hospital and care home beds. Palliative care patients unable to access timely community care may consequently be admitted inappropriately to hospices, impacting on bed availability for those requiring specialist inpatient care.
Methods The admitting doctor documented the primary reason(s) for each hospice admission in real-time. Where social reasons were identified as important, greater detail was obtained from patients notes regarding reasons for admission, length and outcome of stay.
Results During February, March and April 2015, 14.1% (13 of 92) hospice inpatient admissions were primarily due to lack of alternative community care. This led to an additional 107 hospice bed days, a mean of 8.2 days per patient. These patients did not need specialist palliative or end-of-life care and could have remained in the community if adequate care was available. Further results will be collated as the year progresses.
Conclusions Deficiencies in community care accounted for a sizable proportion of hospice admissions; these patients may have been better cared for in their own homes or community beds. This also reduces availability of hospice beds for patients requiring specialist inpatient palliative care.
Application to hospice practice Hospices must review how best to configure future community and inpatient services to meet changing needs of patients. Hospices must also work closely with local care providers to ensure timely access to community care.
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