The Cedars Nursing Home in Bourne has become a leader in Palliative, end of life care and is recognised nationally for its excellence in this area. Helen Brewster, the homes manager has been integral to this and has worked tirelessly across the community in helping to improve understanding in this critical area of care provision. Helen picks up the story.
In 2004, whilst conducting an audit of care practices within The Cedars Care Home, it became apparent that residents being admitted were frailer and life expectancy reduced. We were providing a good standard of care in many areas however, there were noticeable shortfalls in the service being afforded to those residents facing the end stages of their lives. We found:
- Care was reactive
- Multidisciplinary team care was uncoordinated
- Symptom control was inadequate, causing high anxiety for residents, relatives and staff
- Residents were being admitted to hospital to die, even though they expressed a wish to stay in the Home surrounded by people who knew them
- Bereavement care for relatives was patchy, with no documented information to act as guidance
And so the search began to find initiatives that could help improve our performance in this area.
The Home worked closely with the Community Specialist Palliative Care Team and this is where we commenced our crusade, using their expertise, knowledge and guidance. The Liverpool Care Pathway and Gold Standards Framework for Care Homes were brought to my attention. Following a lot of research into both initiatives, ensuring their introduction was achievable and would benefit the residents and team, Deputy Matron and I presented their concepts to everyone involved with the Home. The general consensus was to go ahead with their implementation and so the Home was formally signed up for both in early 2005.
The Gold Standards Framework (GSF) is an enabling, flexible model that allows individual modification to meet the specific needs of residents. This is not a short term fix. It is an initiative that Care Home Teams need to take ownership of and embed into their everyday working ethos.
The aims we set ourselves were:
- To improve the quality of care for residents nearing the end of their lives and ensure they and their significant others had more say in how this was to be achieved.
- To improve collaboration between GP’s, hospitals, primary care teams and specialist care teams
- To reduce the number of unnecessary admissions to hospital in the last stages of life enabling residents to die in their ‘home’
Introducing GSF, which incorporates Liverpool Care Pathway, into the Home brought about a number of changes. Some positive outcomes were achieved, all of which we have maintained over the years. The benefits for our residents and relatives have been significant in a number of areas:
- Better coordinated care
- Better symptom control with anticipatory prescribing
- Fewer crises and unnecessary hospital admissions
- A more dignified, individualised death, respecting the residents wishes and choices
- Proactive care with advanced care planning
- Greater family support
- Better person centred care – physical, psychological, social and spiritual
There have been noticeable benefits for the team too:
- Greater job satisfaction
- Empowered to make improvements in care
- Improved communication and working relationships with the multidisciplinary team and other professionals
- Less stress
- Improved skills, knowledge and awareness of residents needs.
When introducing change into any care environment it is inevitable that challenges will present themselves. For change to be effective you have to change people’s way of working and thinking – not an easy task!
Our first challenge was getting the GP’s on board. Without their leadership and input many aspects of GSF would not be achievable. Getting them to address key issues like anticipatory prescribing was essential. Building stronger relationships with all colleagues was important to ensure understanding of the aims we had set ourselves. Anticipating family needs and finding ways of addressing them. Implementing Advanced Care Planning in a sensitive but effective way and embedding GSF into the overall working culture of the Home. ‘Time’ is perhaps the biggest challenge of all. It is wonderful to want to implement something that you know will make a positive improvement to your residents’ lives but finding the time is sometimes hard. It truly takes team effort and commitment.
We only get one chance to get end of life care right for each resident and their loved ones. At such a highly emotional time people will remember every word, or lack of them, every expression or gesture. Good communication is essential between all parties for an open, trusting relationship to be achieved. Getting it wrong may leave a legacy of grief to a loving family and cause distress to staff. Getting it right makes us really proud to see the positive effect our care has on our residents and their families at such a difficult time
Avery Healthcare is committed to promoting quality in all aspects of our resident’s lives no matter what stage of life they are at or the level of care required. As a team we were proud to achieve a GSF Quality Hallmark, Beacon Status, in recognition of our hard work and commitment to our residents.
Helen Brewster is manager at The Cedars Care Home in Bourne, Lincolnshire and can be contacted on 01778 42155. She is more than happy to advise people on end of life issues.