Report for Diana Princess of Wales Care at Home Trust
Review of Hospice at Home Service 2016
2016 started with 8 patients on the caseload and throughout the year the service received 47 new referrals. The team provided 2,305 hours of care to patients and their families compared with 1,750 hours during 2015. (See figure 1 below). This is a 32% increase in hours delivered from last year. 1,348 hours were provided during the day with 957 hours at night.
During 2016 the team have worked closely with district nurses and the palliative clinical nurse specialist team (PCCNST) to ensure that patients remain at home if that is their wish. Just over half the number of patients (24) referred to the service were supported to stay at home during their last days of life. This was made possible by the flexibility and expertise of the staff.
Since widening of the Hospice referral criteria in May 2016 the Hospice at Home Service has seen an increase in the numbers of patients with non-malignant life limiting disease accessing the service. This year the team cared for 35 patients with a cancer diagnosis and 20 patients with other life-limiting conditions such as motor neurone disease, chronic obstructive pulmonary disease (COPD), end stage heart failure and dementia: in 2015 they looked after only 6 patients with non-malignant life limiting disease and 52 patients diagnosed with cancer.
Respite remains an integral part of the Hospice at Home Service and is provided day and night. The number of hours patients and carers needed varied from 2 hours twice a week, to 9 hours care overnight 1-2 times a week depending on patient/carer need. Carers value a short period of time each week to themselves, and many have expressed the view that without this service they could not have coped.
- The Hospice at Home Service employed two permanent part time 22.5 hour/week health care assistants (HCAs). Employing HCAs allows us to provide a valuable respite service. It also allows us to provide a second person to support the registered nurse when delivering end of life care.
- The on-call service continued for patients who wished to die at home but who requested not to have a nurse in the house overnight.
- Senior nurse (Barbara Lawton – the Diana Nurse) completed the Q.C.F (Quality Credit Framework City and Guilds accredited Assessors course. During this time she acted as a mentor to one HCA who was working towards QCF level 2. With this completed, the HCA has now registered for QCF level 3 and Barbara will continue to act as her mentor.
- Barbara’s attendance at the National Hospice at Home Conference in Bristol allowed her to network with other Hospice at Home teams and find out how they address issues common to all services. It was really useful to share this information with the Hospice team. It challenged Hospice at Home services to develop evidence based research to ensure that the service we provide makes a measureable impact on our patients and their families.
- A patient’s satisfaction questionnaire was sent out from Hospice Isle of Man. One of the organisation’s strategic objectives (2012) is to “continually improve existing service provision for patients ….”
103 questionnaires were sent out to patients on the community caseload (some of those patients had experience of using the Hospice at Home service) We received 33 replies – 32% response for all services but 18 out of 33 replies commented on the Hospice at Home Service. Patients and carers felt they were treated with respect and dignity, were involved in decision making, that staff were kind and caring and they had confidence and trust in the staff. They also felt their problems were managed to their satisfaction and were very satisfied with the support they received
Verbal Comments received:
“Both my husband (as carer) and I get enormous benefit from Hospice at Home. The staff are extremely considerate and understanding to both of us. No improvement necessary.”
“Everything was good and still is.”
“All of my care has been beneficial and I don’t think it can be improved upon.”
Overall, the data shows a high level of satisfaction with the Hospice at Home service.
One of the team’s on-going challenges has been supporting patients out of hours. On the island most services finish at 5pm and there is no overnight provision for patients except the Hospice at Home care provided by our small team and Manx Emergency Doctors Service (MEDS). The team try very hard to be flexible in their approach by working on call when they have a patient dying at home and also by providing a twilight service between 7pm and 10pm. This can be difficult because of the small size of the team, and because both the Hospice at Home Service and Hospice In-Patient Unit draw from the same pool of bank staff. Recruitment of new staff to our bank service is on-going.
As a team we look forward to the opportunities 2017 will bring but our focus will remain in providing care to support patients staying at home for as long as possible, and in dying at home if that is their wish.
We would like to thank the Diana Care at Home Trust and everyone who supports them, for raising our much needed funds to help us continue providing this essential community based service.
Community Services Manager, Hospice Isle of Man.