Background Douglas (BMJ. 1992, 304: 579) wrote about the hospice movement and innovative future care for the dying 30 years ago. Hospice at Home services have developed nationally in response to local demographics, resources and need. More people want to die at home (Ali, Capel, Jones, et al. BMJ. 2015, 9(1): 84–91), where care should be guided locally by our ambitions for palliative and end of life (Ambitions for Palliative and End of Life Care, 2021).
Aims On January 25th 2021, the Hospice at Home service began, with an aim to provide 24hour specialist end of life care to enable patients to die at home as their preferred place of care.
Methods The model is integrated within the health and social care deliveries and voluntary sectors, including Marie Curie, Urgent Care Response, and hospice volunteers. Referrals are received for end of life care (General Medical Council, 2010). There are 5.7 whole time equivalent (wte) specialist nurses (Band 6) including an advanced nurse practitioner (Band 7), and 2.4wte assistant practitioners (Band 4). The 24hour service works with 3-day shifts (08:00–20:00) and an on-call nurse specialist shift (20:00–08:00). This is crucial to service outcomes as providing specialist nurse visits 24/7 enables symptom management and support night and day. Service data for referrals, preferred and actual place of death, caseload, discharge and disease, was collated. Funded by a local charity, quarterly board meetings direct service evaluation and development.
Results In two years, 198 patients died, 180 in preferred place of death (ppd) = 91%. 177 patients died at home or care home (ppd) = 98% avoided unwanted hospital admissions. Referrals and deaths increased by 50%. Overnight call-outs increased by 200%. Preventing admission = £755,333 yearly saving (average 10-day admission in final year of life). Average length on caseload = 96 days. Cost = £2,000 per patient.
Conclusion The Integrated Model for Specialist End of Life care is successful, and showcases future specialist end of life care at home.
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