Aim The main purpose of our project was to assist care home staff with identifying their own residents who may be palliative, opening up ceiling of care/advance care planning discussions, and reducing inappropriate hospital admissions.
Background A survey by BUPA in 2011 found that 72% of new admissions die within 42 months. We were invited by local commissioners to review four nursing home facilities to identify any gaps in meeting their residents’ palliative care needs. Despite heavy encouragement from local commissioners two care facilities declined our input at the beginning. The remaining two care home managers agreed to participate and we completed a baseline review/scoping exercise to understand challenges in maintaining residents in their place of choice. From this individualised review we negotiated next steps in assisting with identification of patients who could die in the next 12 months and look at how this is communicated to all relevant parties.
Results Majority hospital admissions due to infection with underlying morbidity of frailty and dementia. Significant variance in quality of documentation and communication with residents, families and primary care teams. Home A has failed to retain two care home managers since project began highlighting issues with leadership and continuity. The enthusiasm, consistent staffing and ownership of project by staff in Home B has been vital to this project moving forward. We have completed seven ceiling of care documents since May 2018 and have commenced GSF like meetings monthly.
Conclusion None of what was revealed is unique or novel but is a timely reminder of barriers to transforming outcomes for this vulnerable population. The commissioner has acted as an intermediary/broker and unclear if this has led to suspicion, fear of financial penalties and then refusal and inertia to be part of the project.
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