Early Identification in Care Homes (SHADOW)
End of life care is extremely important for care home residents and for all of those around them including care home staff, family, friends and medical staff.
The updated Ambitions for Palliative and End of Life Care describes 6 key principles which support high quality end of life care; the Ambitions Self-Assessment Framework can be used to help plan service improvements (note: the framework should be downloaded).
Unfortunately, although the death of many of our residents in care homes is predictable, conversations and decisions are frequently made in the very last weeks or days of life. This happens largely because we don’t adequately identify residents and plan their care. This often leads to distressing and futile hospital admissions or discussions that feel rushed with little time for carers and family to reflect on what is happening.
We know that when patients have been identified as approaching the last year or so of life and have a care plan reflecting their wishes and preferences this has been shown to improve the quality of life in the last year, months, weeks and days and is beneficial for all of those involved in their care.
There are several ‘tools’ available which enable clinical staff to identify patients who might be approaching the last year of life. These can be quite complicated and require some clinical knowledge.
We have developed SHADOW especially for care home staff to improve their confidence and ability to recognise those residents approaching the end of life. The guide has been developed by summarising key aspects of well recognised identification documents. This has been tested with care homes using Quality Improvement to ensure the guide is user-friendly and applicable in all care homes, both residential and nursing.
SHADOW should not require any additional training but care homes who are engaged with the Six Steps Programme or One Step or have received other training regarding end of life care will find the guide easier to follow. If any care home staff are unsure regarding their resident and whether they are in the last year of life, they are encouraged to seek medical advice.
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 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 and advocates to support high quality end of life care a care home should have:
- A systematic, pro-active approach to residents who may require end of life care;
- 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;
- Seeking support in delivering end of life care from partners organisations including acute hospital, hospices and community nursing teams;
- Care home staff are supported with education and training on palliative care knowledge and skills;
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.
A one-day Advance Care Planning and Communication Skills training course, Mayfly, is available to health and care staff across the Network areas. Information on these courses can be accessed through the Education Hubs.
For The Public
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.