Sharon Cansdale GSF Facilitator

1. Gold Standards Framework for Care Homes (GSFCH) Programme Sharon Cansdale GSF Facilitator

2. Why do we need to develop EOLC in care homes? • Ageing population with multiple problems requiring increasing level of care • 1 in 5 of the UK population dies in a care home • Care for people in the final stages (not just final days) of their life is what is routinely provided in care homes • Pressing need to support care homes to deliver optimal care for patients approaching end of life

3. ‘A good death’ • Being treated as an individual, with dignity and respect. • Being without pain and other symptoms. • Being in familiar surroundings. • Being with family and friends.

4. Findings on care homes • As few as 7%of care home workers and 5% of nursing home care workers have an NVQ level 3 qualification which includes end of life care. Staff turnover rates suggest that care homes are training fewer staff than they lose on an annual basis. • PCTs cited education and training in care homes as the biggest challenge to delivery of EOLC. • 48% of independent and 35% of NHS run hospices rated skills of staff working in nursing or personal care homes as poor. • Both care homes and independent hospices rated PCT commissioning of EOLC poorly. • A significantly higher proportion of people were able to die in care homes if those home had access to nursing staff.

5. What is the Gold Standards Framework? • System of care that promotes one GOLD standard of care for ALL people nearing the end of their life • Modified version of primary care Gold Standards Framework (GSF) • 4 main aims • 1. Improve quality of care for patients nearing the end of their lives • 2. Improve the coordination and collaboration with GP’s and Primary Health Care Teams • 3. To reduce the numbers admitted to hospital in the last stages of life • 4. To share learning with key suggestions in improving end-of-life care in care homes

6. The GSF 3 Processes Identify. Coding patients, keeping a register, monthly meetings,daily handovers, Assess. Main needs, physical, psychosocial and spiritual. Assessment tools, communicate with team, patient and family. Advance care planning Plan. Plan ahead for problems, preferred place of care , out of hours issues, advance care planning. Be more proactive than reactive 3. Plan Communicate 2. Assess Communicate 1. Identify Communicate

7. 3 stage training programmePreparation, training, consolidation + accreditation      Final Appraisal GSFCH Accreditation Workshop 3 Workshop 4 Awareness Raising Meeting Enrolment of Care Homes Local Coordinators Meetings Workshop 2 Workshop 1 ADA Before Ongoing ADA ADA After

8. ‘Gold Standards Framework’ (GSF) ‘Rapid Discharge Pathway’ (RDP) Advance Care Planning ‘Preferred Priorities for Care’ ‘Liverpool Care Pathway for the Dying’ (LCP) 1 2 3 4 5 Advancing disease Increasing decline Last Days of Life First Days after Death Bereavement 1 year 6 months Death 1 year The North West End of Life Care Model End of Life Care Tools Adapted from The North West End of Life Care Model, Healthier Horizons for the North West, NHS North West (May 2008)

9. GSF Coding of Residents in the Care Home A B C D

10. C1 Communication Supportive Care Register, regular meetings. Advanced care planning. C2 Co-ordination Named leads to co-ordinate. Effective team-working and collaboration. C3 Control of Symptoms Assessment tools, guidelines, Specialist Palliative Care Team (SPCT) C4 Continuity Handover form, Out Of Hours protocol, liaison C5 Continued Learning Continued learning in practice C6 Carer Support Practical, emotional, bereavement C7 Care in dying phase Liverpool Care Pathway for the Dying Patient (LCP) GSF: The 7 Key Tasks (7 Cs)

11. The GSF Care Homes Training Programme Goals 1.To improve the quality of end of life care 2. To improve collaborationwith primary care and palliative care specialists 3. To reduce hospitalisation- and enable more to live and die at home

12. What’s in it for the staff? • Improve care for residents • Improves job satisfaction, clinical skills and knowledge • Greater confidence when dealing with other health professionals • Fewer residents going to hospital in last stages • Receive training, support and resources • Improve teamwork • Raise the profile of the home for palliative care in the area.

13. What's in it for residents? • Better care toward the end of life • A better death in accordance with their and their families wishes • Fewer crisis or hospital admission • Encourages proactive care with better advanced care planning • Better symptom control • Attention to psychological, social and spiritual needs • Earlier discussion, more information and greater support given to family • Access to effective out of hours care

14. 20 Key standards- Accreditation checklist Leadership + support Team-working Documentation Planning meetings GP Collaboration Advance Care Planning Symptom control Reduce hospitalisation DNAR +VoD policies Out of hours continuity Anticipatory prescribing Reflective practice+ audit Education + training Relatives Care in final days Bereavement Dignity Dementia Spiritual care Sustainability