Early Identification in Care Homes (SHADOW)

The framework for Enhanced Health in Care Homes published in 2016 includes high quality end of life care as one of the seven care elements within the framework.

The framework advocates to support high quality end of life care a care home should have:

  1. A systematic, pro-active approach to residents who may require end of life care;
  2. Support individuals to die in the place of their choice. This includes advance care planning and residents having personalised care plans and treatment escalation plans and where possible sharing them electronically;
  3. Seeking support in delivering end of life care from partners organisations including acute hospital, hospices and community nursing teams;
  4. Care home staff are supported with education and training on palliative care knowledge and skills;

The North West Model for Life Limiting Conditions is used to support the assessment and planning process for patients in the last 12 months of life. The good practice guide identifies prompts for practitioners at key stages; for example, as patients enter the last months or weeks of life.

The North West Palliative and End of Life Care network has developed a tool for care home staff – SHADOW – to help them identify residents in the last year of life, which can be used in conjunction with the North West Model for Life Limiting Conditions. SHADOW can be used by any member of the care home team and does not require any specialist clinical knowledge. It’s to help staff improve their confidence in identifying patients that might be in the last year of life so that important conversations can take place and plans made.

The SHADOW tool has been developed with the Network’s GP Clinical Leads and tested and refined in several care homes in Cheshire & Merseyside.

SHADOW should provide a systematic and proactive approach to early identification which triggers multi-disciplinary support, discussion, planning and completion of a care plan and other related documentation. It is known that when patients have been identified as approaching the last year or so of life and have a care plan reflecting their wishes and wishes this has been shown to increase the quality of their life and is beneficial for all those involved in their care.

Through the Regulated Care Quality Sub Group, funding was identified to support the design and delivery of three education days to raise awareness of the SHADOW tool with care home staff and provide some taster sessions on communication skills, Advance Care Planning and Care of the Dying Patient.

A one-day Advance Care Planning and Communication Skills training course (Mayfly) is also provided free of charge to health and care staff across the Network areas.  Information on these courses can be accessed through the North West Coast Learning Collaborative.

For The Public

How to find a care home

People’s Voice is a group of lay people who have lived experience of, or an interest in, palliative and end of life care.  If you would like to know more about People’s Voice please visit here.