Introduction A local health needs assessment indicated a need for end of life beds in a care setting for patients who did not want to, or could not, die at home or in hospital and did not have the level of need requiring a Hospice bed. Population predictions suggest this need will increase. A model of a Hospice commissioning and supporting beds in a nursing home was created and is currently being piloted.

Aims The overall aim was to develop a new model of end of life care in a care setting providing high quality care for patients and families.

Project plan This included: developing eligibility criteria, a contract, operational policies, budget; undertaking publicity; preparing environment; planning evaluation; providing education.

Results The first 4 months indicate

Benefits include:

• High quality of care

• Positive patient and carer satisfaction

• Saving of hospital bed days through admission avoidance and earlier discharge.

• Increased choice

• Rapid access to beds

• Reduced paperwork and administration time for professionals

• Increased psychological support for patients and families

• Training and development of care home staffimproved care for all residents

• Improved partnership working with acute trust, hospice and community

• Rapid access to medicines through Hospice nurses prescribing

• Changed perceptions of care homes

• Cost effective

Challenges include

• Identifying patients for referral

• Establishing new referral pathways

• Issues around communication

• Lack of understanding by relatives of medical condition and prognosis

• Transfers felt rushed for some relatives

Conclusions Implementing new models across hospitals and community takes time and presents challenges. However, early indications are that this model of high quality care is successful and has many benefits to patients, families and professionals. It could be replicated in other care homes.