Background Research suggests that deaths in the community are likely to increase (Bone, Gomes, Etkind, et al. Palliat Med. 2018; 32(2): 329–36). Currently there appears inadequate data to identify if people who die at home can access the treatment and care that they need, or whether their care is well co-ordinated (Baylis, Chikwira, Robertson, et al. Dying well at home: Commissioning quality end of life care. The King’s Fund, 2023).
Aims To operationalise a domiciliary model of palliative care which is responsive, productive and equitable to community need.
Methods Commissioners proposed a four times a day care package for up to five patients to aid rapid discharge from hospital/additional care at home. Recruitment was open to anyone wanting to develop a career in care. A bespoke educational package was delivered to staff to enable them to provide holistic care. Patients were deemed eligible for the service if they met the criteria for Continuing health care fast track funding. Once patients have an initial assessment and are accepted onto the service, they have further reviews at weeks 4 and 8. If the patient has plateaued/improved conditionally, an exit strategy is planned with district nursing colleagues.
Results Following a review of the service, it was identified that four visits a day wasn’t needed for every patient, therefore, we could support more patients in their homes. Within the first year of operationalisation of the service, 156 referrals have been received; from this 75 people have been supported to die in their own home. Response rate from referral to care placement was within 24–48 hours.
Conclusion The above data demonstrates that a well co-ordinated service, delivered by a team who have the knowledge and skills to provide the hospice ethos of end of life care can support choice at the end of life.
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