Without expansion of end of life care training for staff in care homes numbers of hospital deaths (of elderly, frail residents with dementia) will increase unsustainably (Bone et al, 2017). The challenges to education in care homes of high staff turnover, funding, time, attitudes, GP support and language and cultural differences (Marie Curie, 2017) impede this but there are established programmes, nationally, with evidence showing that, with high ‘being present’ facilitation supported by multi-layered learning, necessary change in this environment is achievable (Kinley, 2018). Whilst Birmingham St Mary’s Hospice (BSMH) is a Regional Centre for Gold Standard Framework (GSF) Care Home Training and provides a substantial education programme, there is an urgent need to explore how to support local care homes better.
Aims Six months of discovery and design to produce an effective service model which facilitates on site education, embedding of sustainable systems and role modelling to local care home staff to improve their competence and confidence.
Methods Palliative Care CNS seconded for six months to:
Map, scope and identify local and national evidence–based practice
Design a model
Test the model
Collaborate with Birmingham University
Audit and measure outcomes.
Initial results Preliminary interviews with 23 care homes show:
Need for additional support (in particular health care assistants and on site)
Examples of good practice (e.g. regular ANP and GP input)
Uptake of education programme does not reflect the number of care homes
Poor out of hours communication
Poor communication from hospital
Significant number of homes relying on more than two GP practices
Some understanding of advance care planning but need to improve communication with families
only four have embedded use of GSF.
Conclusions Prioritise completion of the Care Homes Project to produce a robust and flexible approach to facilitation. This project will build upon current research to produce innovative strategies in this arena.
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