Extending Frailty Care Grants: Project Details

Gravesend  

Care Home Rehabilitation - seated exercises

An outreach programme of seated exercise classes in care homes to improve strength and mobility and reduce falls among frail patients.

We will run a programme of seated exercise classes (a minimum of one session per week per care home) in five care homes within our catchment area of North Kent. Research has clearly demonstrated the considerable benefit that exercise classes can have for patients’ strength, flexibility and balance, and in slowing or even reversing the development of frailty symptoms.

This project will take ellenor’s seated exercise programme out into the community to improve the quality of life and wellbeing of frail patients within these care homes, and to reduce the risk and severity of falls. 

Award: £49,957

Inverness, Scotland  

24/7 helpline - Education into Care Homes

Frailty in Care Homes 24/7 clinical helpline with remote ECHO education support in the Highlands of Scotland 

Highland Hospice with NHS Highland through its End of Life Care Together partnership programme is seeking to provide enhanced service delivery for those with frailty in care homes. We are looking in partnership with the NHS Highlands Care Home Liaison Team (CHLT) to extend the existing Palliative Care Helpline Line that supports people in the last year of life to those with frailty in care homes.

Through this service and the CHLT we will also identify educational needs in participating care homes and deliver applied ECHO education sessions around topic areas from difficult advanced planning conversations, to symptom management.

Award: £50,000

Welwyn Garden City 

Compassionate Communities

Addressing Frailty: a Community Development approach to living well with frailty, through collaboration and co-ordination of hospice care and local service provision.    

Isabel Hospice seeks to formulate and build a coordinated response to the needs of older people with frailty, both within our care services and the communities we serve. We will leverage existing expertise, partnerships and other assets to develop stronger collaborations with other service providers to support those with frailty to live well for longer.

Award: £30,896

Swindon

Virtual Ward

Establishing person-centred proactive patient centred decision-making working in collaboration with the Swindon community virtual ward and ensuing smooth and timely transition to EOL care.  

Hospice consultants and clinical nurse specialists will attend daily patient reviews, have conversations with medical and nursing staff to help shape thinking, rationalise deprescribing, provide education, patient assessment, facilitate referral pathways, provide advice and support for patients needing palliative and end of life care, and their families and those that matter to them. Learning will be applied and the model adjusted to meet patient and family needs during the duration of the project.  

Award: £49,983

Harrogate  

Partnership Working - Care Co-ordinator/Pathway Streamlining

Frailty Care Connector: providing personalised support for people living with severe frailty.    

We will recruit a Frailty Care Connector to work alongside and support people living with severe frailty, scoring over six on the Rockwood Frailty Scale. Personal assessment will include co-producing a personalised health and wellbeing support plan, including referring and signposting to community groups and statutory services. Our Care Connector will work with people for 12 weeks. Re-referrals can be made as required.    

Award: £37,230

Worthing 

Rehabilitation & Patient Journey

Rehabilitative palliative care to identify and provide proactive planning, care and support to older people living with frailty.    

A growing number of older people are living and dying with frailty in our area that currently do not access our services. Additionally, some of our services do not provide the right support and interventions for this group.

This project is designed to pilot a frailty pathway as part of our Living Well service. We will establish clear referral routes, triage, activities and access to wider support services linking people with frailty and their carers to services available enabling them to live well, stay independent at home for longer and make decisions about, and plan, their care for the future.    

Award: £46,606

Crawley    

Outreach/Education

Supporting older people at risk of advancing frailty to live well: A collaboration between St Catherine’s Hospice and Leith Hill GP Practice.    

Living with frailty increases the risk of sudden changes in capacity, independence and death from small stressors. The time uncertainty of these potential impacts indicates that early hospice involvement for older people are at risk of advancing frailty, would be beneficial.        

Award: £21,275

London  

Residential Care Home - Education & Family Support

The connections project: Living and dying well with frailty    

Older people living with frailty in residential homes rarely engage with palliative care, meaning their palliative care needs are often unknown or unmet. This project will work with 9 residential homes, GPs, Pharmacists, Age UK and members of the Croydon Integrated Care Network to better support this populations’ engagement with palliative care and promote living well now.  

Award: £48,648

Hastingwood

Domiciliary Care

A new Frailty Lead role to provide education and training in palliative care to domiciliary care workers, enabling them to better diagnose those with clinical frailty, undertake effective assessment of need, and improve care for those with advancing frailty at end of life.

The role will provide ongoing support and advice to care workers, including access to a 24-hour helpline. We plan to upskill domiciliary care providers with the information, skills and confidence they need to provide high quality palliative care to patients in their own homes, as well as to reduce incidents of unscheduled and emergency acute care at EoL.    

Award: £46,205

Denny, Scotland 

Prisons

Identifying and Supporting Frail People in Prisons: introducing frailty screening and management to support the ageing prison population. 

This project will focus on supporting people 65+ experiencing frailty at HMP Glenochil. Populations in prisons across the UK are ageing and Glenochil houses an even higher number of older, frail people. Prisoners with deteriorating health are supported by an NHS team, the Scottish Prison Service Officers (SPS), carers from local agencies, peer carers and visits from specialist healthcare providers.

This structure is a good start, but there are gaps: there is currently no frailty screening in place.  We would like to provide the tools to these groups to identify, assess and support existing and future frail people in prisons.    

Award: £49,957

Blackpool 

Community Pathway - Partnership

Blackpool Extended Community Frailty Partnership / Specialised Frailty Nurse    

Community Extended Frailty Partnership (CEFP), between hospice, hospital and community frailty improves co-ordinated care in communities by responding earlier and closer to home to peoples care and wellbeing needs. The CEFP targets high-risk patients and addresses a major ‘system issue’ by particularly targeting those patients with greater care needs and frailty risk who are diagnosed late and/or discharged late. This helps address our terrible health inequalities.

The CEFP improve care in community by co-ordinating higher quality, bespoke support through hospice led/Specialist Frailty Nurse and partnership interventions. This approach is being developed as a local model that will be spread regionally/nationally through educational spread & adoption.    

Award: £50,000