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)

The value of a night service for Hospice-at-Home: reasons for making contact at night

Background. People approaching the end of their lives have physical and psychological needs that should be met in a timely way, at any point during the night or day, and met in a way which addresses their needs and preferences. Crises at any time requires prompt, safe and effective urgent care (NICE 2011). Methods. Rennie Grove Hospice Care (RGHC) provides 24/7 care, with a night service available from 9.15pm to 7.15am. RGHC conducted an independent study to identify the value of the service, including reasons people make contact at night and how many calls could be settled without a visit. Over the study period (145 nights) each call was charted with demographic details, reason for call and outcome. Results. 550 calls were received, resulting in 335 visits. On 7 nights there were no visits, the highest number in a night was 9, with an average 3.79 visits per night. Only those consenting to participate were analysised, reducing eligiblity to 351 calls and 208 visits. Of these, reasons for a night visit included symptom control (64%), carer support (19%), death (13%), death verified by night team (9%), message (7.5%), planned visit (7%) and “other” (4%). Major symptoms included pain (42%), anxiety (32%), nausea (17%) and a small number with chest problems, bowel issues, pyrexia, syringe pumps. In 143 cases a visit was not necessary due to telephone reassurance (55%), another service being more suitable (12%), the team were too busy (8%), and 12% were handed to the next shift. Conclusions. The night team plays a vital role in 24/7 care, with 40% of calls being managed without a visit. Visits were, in the main, for symptoms or problems concerning support. Death, for a Hospice at Home service also becomes a significant issue requiring a prompt and caring response