Hospital-hospice partnerships in palliative care: creating a continuum of service

42 pages.Reports on the cooperation of hospitals with hospices to provide palliative care

The cost of a night nursing service at Rennie Grove Hospice Care (RGHC), and the total community cost of care at home compared to an admission to hospital

Background. RGHC runs a Hospice at Home service providing 24/7 care. An independent study calculated the cost of a RGHC visit and the total community cost of home care, including all health care professional (HCP), carer, and family member visits. Methods. Over a period of 145 days, 550 calls and 335 visits made to/by the night team were recorded, averaging 3.79 per night. The salary cost per hour for each nurse, plus organizational add on costs, was calculated. To derive a total community cost, 35 families, considered by the nursing team to be able to consent, kept a diary for up to two-weeks, recording all HCP, carer and family support visits and duration of each visit. 17 diaries were returned. Descriptive analysis was used with the Statistical Package for the Social Sciences (SPSS v22). Costs were taken for HCPs and social care services from the PSSRU data 2015/16. Results. The average length of the diaries was 10.4 days. For 3.79 visits per night the cost per visit was £195 (taking into consideration that RGHC nurses travel in pairs). The 17 patient diaries covered a total of 177 days and showed a range of visits and complexity of care. RGHC staff provided 19% of the care at a cost of £3295; district nurses 13%, cost £2005; and formal carers 55% at a cost of £1344. 23 GPs visits comprised 4% of all visits but 15% of total costs. MacMillan/Marie Curie nurses accounted for just 2% of visits but 19% of cost as they stayed overnight. The entire cost of 177 days of care for 17 patients at end of life was £11,814; ie £66.7 per day as care was not needed every day of each diary period. Conclusions. The cost of home care seems acceptable, compared to the national average cost of a day in an inpatient specialist palliative care bed at £397-£400 (Data.Gov.UK 2015)

VA transforms end-of-life care for veterans

12 pages.Reports on achievements and improvements in end-of-life care for veterans in Veterans Affairs facilities

How satisfied are carers/families with a night team service, as part of 24/7 hospice at home care?

Background. Rennie Grove Hospice Care (RGHC) runs a 24/7 service with an on call night team. Through an independent study, carer’s levels of service satisfaction with the night team were investigated. Methods. A questionnaire was sent to carers (n=268) who had a relative die under the care of RGHC within the last 6 weeks to one year, 84 completed questionnaires were returned. Follow-up face-to-face semi-structured interviews were carried out with carers (n=18). Quantitative data was analysed using SPSS v 22, while qualitative data was thematically analysed. Results. The carer questionnaire reported that 71% thought the speed of the response by the night team was fast. Overall satisfaction with telephone call response was high with 82% very satisfied. Cares also agreed strongly that the telephone calls provided good quality of care (90%), good follow-up care (88%), that they were given sufficient time (88%), and received useful advice (83%). For a visit, 93% of carers were highly satisfied and 7% satisfied. Carers strongly agreed that they were given sufficient time (90%), and were confident in the care provided (90%), care was useful (87%) and follow-up was good (84%), worries were reduced (81%) and they had a say in decisions made (81%). During the interviews, carers described the night service as: supportive, amazing, caring, reassuring, professional, kind and compassionate, excellent, loving, calm. Carers perceived the service to be holistic and rated the service highly for supporting them to ensure family members could be cared for at home, as preferred. For comparison, of those dying in hospital, only 46% were highly satisfied. Carer wellbeing scores were lower than the national average, but reported similar levels of anxiety. Conclusions. A night team service can provide excellent, reassuring and holistic care that meets the care needs and wishes of the patient and family

The hospice-veteran partnership toolkit

87 pages.Information to help veterans find palliative care and hospice facilities

The role of social workers in palliative, end of life and bereavement care

Social work has an important role in the delivery of meaningful palliative, end of life and bereavement care. Some social workers are palliative care social workers, working in services which specialise in this area of support. All social workers will encounter people who are experiencing loss, the end of life or bereavement. This resource aims to ensure that people benefit from good social work at the end of their life, and that those close to them are supported during this time and into bereavement

The support needs of terminally ill people living alone at home: a narrative review

Context: The number of terminally ill people who live alone at home and without a caregiver is growing and exerting pressure on the stretched resources of home-based palliative care services. Objectives: We aimed to highlight the unmet support needs of terminally ill people who live alone at home and have no primary caregiver and identify specific models of care that have been used to address these gaps. Methods: We conducted a narrative review of empirical research published in peer-reviewed journals in English using a systematic approach, searching databases 2002–2013. This review identified 547 abstracts as being potentially relevant. Of these, 95 were retrieved and assessed, with 37 studies finally reviewed. Results: Majority of the studies highlighted the reduced likelihood of this group to be cared for and die at home and the experiences of more psychosocial distress and more hospital admissions than people with a primary caregiver. Few studies reported on the development of models of care but showed that the challenges faced by this group may be mitigated by interventions tailored to meet their specific needs. Conclusion: This is the first review to highlight the growing challenges facing community palliative care services in supporting the increasing number of people living alone who require care. There is a need for more studies to examine the effectiveness of informal support networks and suitable models of care and to provide directions that will inform service planning for this growing and challenging group

Cancer patients’ family members’ experiences of the information and support provided by healthcare professionals

Objective: This qualitative study aimed to understand the experiences, information and support needs of family members of cancer patients, and their satisfaction with the services provided to them as a family member. Design: An inductive qualitative and critical realist approach to data collection and analysis was taken. Methods: Purposive sampling was used to identify family members of cancer patients. We conducted semi-structured interviews with 10 participants over email, enabling us to explore sensitive topics at a pace appropriate for each participant and gain rich sources of information. We analysed the data using an inductive thematic analysis. Results: Three superordinate themes were identified: information acquisition; seeking support; and family members’ experiences of cancer. Needs were high, and a complex relationship between information and support was apparent. Many participants felt dissatisfied with the support and information received as it was sometimes inconsistent, incorrect or vague; and some reported deterioration in their own health as a consequence. Online communities were reported as being very informative and supportive as the participants felt they could relate to the first-hand experience of the other members. Conclusion: Improving healthcare professionals’ awareness of the type of information and support the family members need is vital for both family members and patients. There is a need for the development of educational and psychological interventions to assist family members in coping when a loved one is diagnosed with cancer, is undergoing or recovering from treatment or is receiving palliative care