The national picture The NSF for Older People emphasised the need to provide the right care in the right place at the right time. Hospital is not necessarily the best place for older people, unless they are in need of acute medical or surgical intervention (Department of Health, 2001). Admissions are expensive (Department of Health, 2004) and often a frightening experience, particularly for those who are frail and vulnerable; people with advanced dementia are particularly vulnerable and frequently admitted to hospital, often unnecessarily (Department of Health, 2009).

In view of this St Giles Hospice are working with Virgin Care and SES CCG to support care homes in providing end of life care to their residents by providing expert support and implementation of key tools to help identify residents in their last 12 months of life.

Aims and objectives of the service

• Development of a ‘Planning Ahead’ register of frail patients at risk of admission or likely to be in the last 12 months of life using recognised and evidence based prognostic indicator(s)

• To ensure residents on this register have a care plan and advance care plan where appropriate

• To ensure valid DNACPR is in place for patients

• To ensure a valid RESPECT document is in place (where appropriate)

• To deliver reduction in the number of unplanned emergency admissions to hospital.

Outcomes and the future Currently St Giles Hospice are working with 25 homes providing weekly support sessions and review of the planning ahead register. There has been an increase in people achieving preferred place of death enabling 80% to die in their care home and of all admissions to hospital during this period only one was found to be avoidable. Quarterly reports/evaluations are collated with the aim to increase this service to all care homes within our area.