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Care home pilot improves quality of end of life care for patients in Morecambe Bay

Lindsay Pinch and Alison Nicholson

[A] partnership project between University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) and Kendal Integrated Care Community (ICC) has had a positive impact on the quality of the final days of life for a number of people residing in long term care settings in Morecambe Bay.

The Integrated Cross-Bay Care Home pilot has enabled support for a number of residents in residential homes whose wish is to die in their own home rather than in hospital.

The pilot involved hospital and community nurses meeting with Morecambe and Kendal care home residents, their families and GPs at an informal tea party to have a conversation about what choices are available for end of life care. The aim was to help individuals make an informed choice about their preferences at the end of their life and agree a plan of care that all parties were comfortable with.

Following these conversations, over a 3 month period, there was a reduction in the number of residents admitted to hospital to die. In Morecambe the number of patients admitted to hospital at the end of their lives reduced from 34 to 16. When combined with the results from Kendal the overall result was that out of 114 residents who chose die at home only 16 died in hospital.

The Kendal Care Home project which aimed to ensure that an individual’s wishes were followed when nearing the end of life, was led by Alison Nicholson the Lead Nurse and Advanced Nurse Practitioner working within the Kendal Integrated Care Community (ICC) and Lindsay Pinch the Bereavement Nurse Specialist at the University Hospitals of Morecambe Bay (UHMBT) working with three local GP practices.

The Kendal ICC and the UHMBT bereavement team recognised that between 2014 and 2016 there was a significant increase in the number of patients from residential homes who were dying in hospital.,

Alison Nicholson said: “There were a significant number of older people coming in to hospital, sometimes three or four a month, having a very short length of stay and then dying. They had actually lived in their care home for months and years and we felt that it would be better for them and their families to remain in their home in surroundings they are comfortable with, wherever possible.”

Across Kendal, there are eight care homes with 432 residential, nursing and dementia beds. In Lancaster and Morecambe there are 32 residential homes with 628 available beds (not including nursing home placements).

Alison continued: “A lot of it boils down to the education and the support that the residential staff receive when they are trying to deal with someone who is poorly in a care home. Nursing homes have nurses, but residential homes don’t so we needed to support these residential homes to help people stay in the homes at the end of their lives rather than send them to hospital.

“We want to work with residents and the families. When you are in a care home it’s best that you plan ahead for example who you want to look after you, where you want to be nursed; those big decisions.”

Lindsay Pinch, Bereavement Nurse at UHMBT said: “rather than a formal session, we held a tea party with lots of cake and said, ‘Let’s have a chat, let’s talk about your future plans’ and so many people with different types of illnesses participated.

“Their families came along and participated and at the Morecambe tea party, all the GPs came along as well – it went well with everyone taking on board people’s opinions.

“Sadly there isn’t always a magic wand in hospital, as much as we would love to make people who are at the end of their life better and help them live another five years, we can’t always do that.

“What we can do is to work with families, care home and nursing home staff to ensure that people can choose to die in a their preferred place rather than a busy and unfamiliar hospital environment.”

The success of the scheme has now seen Alison Nicholson appointed into a joint post working across the local community and within UHMBT to better educate all those involved in providing care at the end of a person’s life. Following on from the success of the pilot, discussions are taking place with the GP’s in the Lancaster ICC’s to fund a similar joint nurse post to cover the Lancaster care homes.

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