During the COVID-19 pandemic, GPs were less able to visit care homes and provide support for patients at the end of life. Some people with end of life conditions were in a cycle of being admitted and discharged from hospital, and the hospital was already overloaded with patients. Care homes were struggling.
Compton Care hospice was able to help by employing a clinical nurse specialist (CNS) to support care homes.
Outcomes
The clinical nurse specialist (CNS) works with three care homes. Instead of having a case load of patients, the CNS supports staff with advance care planning (ACP), completing RESPECT forms and making sure patients’ wishes are known and documented. They also work to put anticipatory medication in place.
The hospice is now delivering regular training for care home staff about how to have ACP and end of life conversations. Some staff report that they haven’t had training like this in years.
Facilitators, challenges and advice
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Key facilitators
Care homes have been very receptive to the hospice’s support – the health and care system has been under such huge pressure that they have been very grateful for support.
Challenges
The hospice has struggled to access data from the hospital, to find out the impact of the programme on admissions. However there us anecdotal evidence from care homes that the hospice support is having a positive impact on the care they provide for patients.
Tips and advice
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Form a strong connection with primary care. Make sure the hospice is represented at multi-disciplinary team meetings (MDTs) where relevant. Support members of your clinical team to attend as part of their development – this will also help free up the capacity of senior staff.
It was important to start with that the hospice CNS didn’t carry a caseload – this enabled them to support everyone rather than just focusing on a small number patients.
Future development
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The hospice plans to extend this service to eventually cover all 75 care homes in their area. They have committed to funding this themselves.
For the next financial year, the team has been increased to 5 clinical nurse specialists. Because there will be more capacity in the team, CNSs will each carry a caseload.
