Supporting people where they want to be: Strathcarron Hospice’s care at home

Source: Hospice UK

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Date of publication: January 2020

Publication type: Blog Item

In a nutshell: Strathcarron Hospice in Scotland is the only hospice in Scotland to offer the Hospice@Home service. It launched in 2014 and has reduced the hospice’s waiting list by caring for those that need it in their own homes.

Length of publication: 1 page

Transferring patients home to die: what is the potential population in UK critical care units?

Source: BMJ Supportive & Palliative Care 2017; 7: 98-101

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Date of publication: March 2017

Publication type: Short report

In a nutshell: This retrospective cohort study was undertaken to describe the size and characteristics of the critical care population who could potentially be transferred home to die if they expressed such a wish.

Length of publication: 4 pages

Development of the Carers’ Alert Thermometer (CAT) to identify family carers struggling with caring for someone dying at home: a mixed method consensus study

Source: BMC Palliative Care 2015 14; 22

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Date of publication: May 2015

Publication type: Research article

In a nutshell: The aim of the study was to explore what professionals and carers of patients with cancer and advanced progressive illness, in their last year of life, find burdensome and to develop an alert system for use by non-specialist staff. A mixed-method, multi-phased, consensus study sequentially utilising qualitative and quantitative data to develop and pilot the Carers’ Alert Thermometer (CAT). 245 people participated in the study across a range of health and social care settings in the North West of England (2011–2014). The results identified a number of key domains for inclusion in the CAT. The 8 domains fit within two overarching themes of the reported carer experience; the support needed by the carer to provide care and the support needed for the carer’s own health and well-being. The resultant CAT is an evidence-based alert thermometer consisting of 10 questions, guidance on the possible actions for each alert and space for an action plan to be jointly agreed by the assessor and carer. Preliminary piloting of the CAT has shown it to be valued, fit for purpose and it can be administered by a range of personnel. In conclusion, the CAT enables the identification of current and potential future needs so a proactive approach can be taken to supporting the carer as their role develops over time, with a view to enhancing their well-being and preventing avoidable hospital admissions; ultimately supporting patient choice to remain in their own home.

Length of publication: 21 pages

 

Exploring the cost of care at the end of life

Source: The Nuffield Trust

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Date of publication: September 2014

Publication type: Research report

In a nutshell: This report explores the cost of care at the end of life’ uses anonymised person-level datasets to estimate the costs at the end of life relating to GP contacts, community nursing, local authority-funded social care, hospice and hospital care. The research also explores whether reduced hospital activity and costs at the end of life were likely to be offset by increased care costs in other health and social care settings using the Marie Curie home-based palliative care nursing service. The results suggest that cost savings might be available if community-based support were made more widely available to help people to die in their own homes, where that was their preference.

Length of publication: 31p.

 

Dutch model offers new approach to home care

Source: Australian Ageing Agenda

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Date of publication: August 2014

Publication type: Web article

In a nutshell: The Buutzong model of nursing, where small teams of nurses provide home care services, supported by technology and with minimal administrative nursing, is spreading internationally. Under the model, small teams of up to 12 nurses work in close collaboration with patients, doctors, allied health professionals and informal community networks to support the patient.

While the costs per hour are higher from employing registered nurses, savings are made through lower overhead costs and a reduction in the overall number of care hours required per client.

Acknowledgement: ehospice

National Survey of Bereaved People (VOICES), 2013

Source: Office for National Statistics

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Date of publication: July 2014

Publication type: Statistical Report

In a nutshell: Key findings from the 2013 National Survey of Bereaved People suggest:

• Overall quality of care has not changed significantly between 2011, 2012 and 2013.
• Quality of care was rated significantly lower for people who died in a hospital, compared to people dying at home, in a hospice or care home.
• For those dying at home, the quality of coordination of care was rated significantly lower in 2013 compared to 2012.
• The dignity and respect for patients shown by hospital nurses and hospice nurses has increased between 2011 and 2013.
• Pain is relieved most effectively in the hospice setting (62%) and least effectively at home (18%).
• Only one third of people (35%) who express a preference to die at home, actually die at home.

Length of publication: 24 pages

 

Commissioning home care for older people

Source: Social Care Institute for Excellence

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Date of publication: June 2014

Publication type: Guidelines

In a nutshell: This guide captures the latest research findings on this important and emerging area of social care. It also provides some practice examples of good work in this area. The guide is aimed at health and social care commissioners of home care services for older people with complex needs.

Length of publication: 40 pages

 

Dying at home: A qualitative study of the perspectives of older South Asians living in the United Kingdom

Source: Palliative Medicine 2014 v.28(3), p.264-272

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Date of publication: March 2014

Publication type: Article

In a nutshell: This article aims to explore beliefs, attitudes and expectations expressed by older South Asians living in East London about dying at home. Findings suggest that older people of South Asian ethnicity living in East London perceive home as more than a physical location for dying relatives. They make efforts to adhere, and also adapt, to important social and cultural values relating to death and dying as part of the wider challenge of living in an emigrant society.

Length of publication: 8 pages

Some important notes: Please contact your local NHS Library for the full text of the article. Follow this link to find your local NHS Library.

 

A qualitative study examining the sustainability of shared care in the delivery of palliative care services in the community

Source: BMC Palliative Care

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Date of publication: August 2013

Publication type: Article

In a nutshell: This paper focuses on the sustainability of existing palliative care teams that provide home-based care in a shared care model. For the purposes of this study, following Evashwick and Ory (2003), sustainability is understood and approached as the ability to continue the program over time. Understanding factors that influence the sustainability of teams and ways to mitigate these factors is paramount to improving the longevity and quality of service delivery models of this kind.  The article concludes that this study may inform program and policy specific to strategic ways to improve the provision of team-based palliative home care using a shared care model, while simultaneously providing direction for team-based program delivery and sustainability for other jurisdictions.

Length of publication: 17p.

 

Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers

Source:  The Cochrane Library

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Date of publication: June 2013

Publication type: Systematic Review

In a nutshell: A new review from the Cochrane Pain, Palliative and Supportive Care Group looked at the impact of home palliative care services on the chances of dying at home and on other outcomes for patients and their caregivers, such as symptom control and quality of life. The review team also aimed to compare resource use and costs associated with these services and summarize the current evidence on cost-effectiveness.

Length of publication: 281 pages

Reduction in symptoms for homebound patients receiving Home-based Primary and Palliative Care

Source: Journal of Palliative Medicine

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Date of publication: Online ahead of print: 8 June 2013

Publication type: Article

In a nutshell: The purpose of this study was to determine whether high symptom burden decreases following Home-Based Primary and Palliative Care (HBPC) enrollment. The article concludes that in a chronically ill population of urban home-bound, patient symptoms can be successfully managed in the home. The authors recommend future work should continue to explore symptom assessment and management over time for the chronically ill home-bound.

Some important notes: Please contact your local NHS Library for the full text of the article. Follow this link to find your local NHS Library.

 

A ‘good death’ at home: community nurses helping to make it possible

Source: British Journal of Community Nursing, v.18(1),  pp40 – 42

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Date of publication: January 2013

Publication type: Article

In a nutshell: This article discusses current end of life policies and how the community nurse is central to their implementation. It draws on some recent research which has identified the important steps that enable a community nurse to facilitate a good death and a particular research study which illustrated the unique role of the Community Nurse in providing end of life care in a rural setting, but also the challenges.

Length of publication: 3 pages

Some important notes: Please contact your local NHS Library for the full text of the article. Follow this link to find your local NHS Library.

Acknowledgement: Internurse

In-Home Palliative Care Allows More Patients to Die at Home, Leading to Higher Satisfaction and Lower Acute Care Utilization and Costs

Source: Agency for Healthcare Research and Quality

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Date of publication: April 2012 (updated)

Publication type: Report

In a nutshell: Kaiser Permanente developed a home-based model of palliative care that uses an interdisciplinary team of providers to manage symptoms and pain, provide emotional and spiritual support, and educate patients and family members on an ongoing basis about changes in the patient’s condition. One randomized controlled trial and one comparison-group study showed that the program increases patient satisfaction, increases the portion of patients dying at home rather than in the hospital, and reduces emergency department visits, inpatient admissions, and costs.

Some important notes: The related Quality Tool can be found by following this link – The TriCentral Palliative Care (TCPC) Program Toolkit

End of life care training for paramedics in west Essex

Source: National End of Life Care Programme

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Date of publication: March 2012

Publication type: Case Study

In a nutshell: A hospice run training programme in Romford on end of life care  for paramedics has resulted in a reduction in avoidable hospitalizations. The training sessions cover subjects such as just in case boxes, medication, syringe drivers, GSF, LCP, PPC and general trouble-shooting.  One outcome has been an improvement in partnership working within the community teams.  Additionally, a booklet containing examples of best practice and examples of end of life care scenarios has been produced and is now carried by all paramedics in Romford.

Length of publication: 1 webpage

Acknowledgement: National End of Life Care Programme