Background During the COVID-19 pandemic, the Hospice at Home (H@H) team were divided into three localities, resulting in an enlarged, but divided, team. Registered Nurses (RNs) within the team subsequently needed to co-ordinate the Health Care Assistant (HCA) workforce and assess patients for a prognosis of less than 12 weeks for funding purposes. Senior RNs in one team audited the processes, finding that six months into the new model, people in our care were not always being reviewed for health needs in a timely way; often received H@H care for longer than the commissioned 12 weeks; were difficult to assess remotely, and sometimes deteriorated whilst receiving only domiciliary care visits.

Aim To create a smooth pathway for managing the patients and the HCA workforce to greatest effect.

Methods

• Spreadsheet devised to track and monitor each patient through their time with H@H.

• Validated tools from the OACC suite of measures used to map people’s condition and deterioration.

• Speed of decline (Watson, Armstrong, Back, et al. (2016) Palliative Adult Network Guidelines. 2016, 4th ed.) taught and used as an indicator of prognosis, to aid decisions about ongoing care.

• RN joint visits with HCAs to support, educate and facilitate performance of assessment during care visits to maximise input.

• HCAs taught to give complementary therapies during respite visits.

Results An increase in patients being discharged to Adult Social Care (ASC) if they stabilised, freeing up visits for those who were at end of life. Cross-charging to ASC when appropriate, saving money. Length of time of patients receiving H@H care reduced to the commissioned 12 weeks for the majority of patients, demonstrating the value of accurate identification of end of life. Better use of HCA time, increased job satisfaction and team bonding for the H@H team.

Conclusion HCAs felt supported and educated, whilst the patients benefited greatly from clearer identification of the end-of-life stage and more tailored care.