Facilitator: INSERT NAME Step 1

1. Facilitator: INSERT NAME Step 1

2. Objectives Step 1 objectives: • Identify the national, regional and local end of life care drivers • Recognise the 6 Steps to Success programme • Have knowledge of their role and responsibilities • Recognise how the North West End of Life Care Model and Tool supports the Supportive Care Record • Recognise when is the appropriate time and who should be involved in undertaking end of life care discussions • Identify the necessary Communications skills required for Domiciliary Care Workers in end of life discussions

3. Drivers • National End of Life Care Strategy (DoH, 2008) • National EOLC programme – The Route to Success • Care Quality Commission – Essential standards • National quality markers • Duty to individual for whom we provide care and support for and their families when end of life approaches

4. The North West End of Life Care Model

6. Six Steps to Success Programme Domiciliary Care • Organisation Providing management structure in end of life care i.e policy, educated workforce, collaborative working… • Workforce Developing the knowledge, skills and confidence of the care worker to deliver high quality end of life care Both programmes are interlinked, however contribute with different influences and actions

7. EOLC Quality Markers for Domiciliary Care • EOLC action plan and policy • Effective systems to identify and record those approaching EOL, and wishes (ACP) recorded / communicated • Holistic assessment and care plan awareness • Consider needs of carer • 24/7 co-ordinated, accessible care – across organisational boundaries • Access to relevant training • Awareness of process with end of Life Care Plans (or equivalent) • Systems to monitor and evaluate EOLC provision

8. Expectations • Support colleagues with the delivery of end of life care • Action from workshop: develop an end of life care role • Identify own learning needs • Communicate appropriately and effectively • Build resource/reference files of information • Professional / personal development

9. Six Steps Workshops Step 1 – Discussions as the end of life approaches Step 2 – Assessment, care planning and review Step 3 –Co-ordination of care Step 4 – Delivery of high quality care in domiciliary care Step 5 –Care in the last days of life Step 6 – Care after death

10. Policy to delivery National Strategy Regional Strategy Local Strategy Point of care delivery

11. End of life care is care that: Helps all those with advance, progressive, incurable illness to live as well as possible until they die. It enables the supportive and palliative care needs of both patient and family to be identified and met throughout the last phase of life and into bereavement. It includes management of pain and other symptoms and provision of psychological, social, spiritual and practical support National Council for Palliative Care

12. End of life care is underpinned by: • An active and compassionate approach to care that ensures respect for and dignity of the patient and family • Partnership in care between patient, family and health and social care professionals • Regular and systematic assessment of patient/ carer needs incorporating patient consent at all times • Anticipation and management of deterioration in the patient state and wellbeing • Advance care planning in accordance with patient preferences • Patient choice about place of care and death • Sensitivity to personal, cultural and spiritual beliefs and practices • Effective coordination of care across all teams and providers of care who are involved in the care of patient and family

13. Models/Tools of Delivery ACP Six Steps GSF PPC

14. Step 1 Discussions as the end of life approaches “Allowing an individual to die with dignity in the comfort of their own home, with their own family around them is a key measure of good end of life care provision. A key challenge for domiciliary care workers is to the extent as to which it is appropriate for them to become involved in an individual's discussions about their personal wishes and preferences of care” The Route to Success in End of Life Care – achieving quality in domiciliary care

15. Definition People are ‘approaching the end of life’ when they are likely to die within the next 12 months (GMC, 2010) Includes those whose death is imminent and those with: • Advanced, progressive incurable conditions • General fraility and co-existing conditions with 1yr expectancy • Existing conditions with risk of sudden acute crisis • Life threatening acute conditions

16. End of life care is.... • “The care, treatment and support that is provided to enable a person with an advanced, progressive and incurable illness to live as well as possible before they die. • End of life care also covers the management of pain and other symptoms, the provision of psychological, social, spiritual and practical support, and support for the family into bereavement” (Dept of Health, Route to Success)

17. Activity – Tools/Models • North West Model • North West Tool • Case studies • Supportive Care Record • Prognostic Indicator Guidance (GSF) • Surprise Question

18. In End of Life Care Communication Skills

19. Communication Skills Effective communication is an important and essential part of end of life care Communication helps us to understand the individual – their needs and wishes

20. Good communication • Right time • Right place • Observing the individual’s body language • Consider non-verbal messages • Appropriate personal space • Appropriate touch

21. Listening Skills Active listening: • Give full attention • Listen for feelings • Minimal responses • Repeating • Reflecting • Use of silence

22. Non Verbal Skills At the end of life, speech may become more difficult. You may need to use observational skills to understand what the person is attempting to say through their body language What are non verbal skills?

23. Communication points • Empathy: Putting yourself in the person’s shoes • Blocking: “Don’t talk like that” • Repetition: Seeking reassurance or clarification • Direct questions: “Am I dying?” • Be honest: “ I might not be the best person to speak to you about this...”

24. Limitations in the carer role • Find it difficult to communicate on issue • Unsure if you are allowed to discuss issues • Don’t have the answers • Not the right person for the conversation • Be prepared to refer to your manager for end of life discussions to take place with appropriate other(s)

25. Discussion triggers • Change in circumstances • Wants to have conversation • Comfortable with care worker • Relatives involvement/prompt • Mental capacity/changes

26. Acknowledgements • Basic counselling skills, a helpers manual – Nelson, J.R. (Sage) • Tribal Ltd • Skilled interpersonal communication – Hargie, Owen & Dickinson, D (Routledge) • Janice Roe-Evans, Tutor, WMC

27. Objectives Step 1 objectives: • Recognise how the North West End of Life Care Model and Tool supports and End of Life Care Register • Recognise when is the appropriate time and who should be involved in end of life care discussions

28. Onwards... • ‘To Do’ List • Reflective practice • Activity – What makes a good death? • Evaluation of session • Next session: Step 2: Assessment, care planning and review