Sharon CansdaleSharon CansdaleGSFGSF

FacilitatorFacilitator

Gold Standards Framework for Care Homes (GSFCH) Programme

Why do we need to develop Why do we need to develop EOLC in care homes?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

‘‘A good death’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.

Findings on care homesFindings 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.

What is the Gold Standards What is the Gold Standards Framework?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

The GSF 3 ProcessesThe GSF 3 Processes

1. Identify

2. Assess

3. Plan

Communicate

Communicate

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

Communicate

3 stage training programme3 stage training programmePreparation, training, Preparation, training,

consolidation + accreditationconsolidation + accreditation

Stage I Preparation Stage II Training Stage III Consolidation + Sustainability

3-6 months workshops in 9 months 9 – 12 months

Awareness Raising Meeting

Local Coordinators

Meetings

Workshop 1 Workshop 2 Workshop 3 Workshop 4 GSFCH Accreditation

ADAAfter

ADABefore

Final Appraisal

Ongoing ADA

Enrolment of Care Homes

‘Liverpool Care Pathway for the Dying’ (LCP)

Last Days of Life

First Days after Death

1 year1 year

Advancing disease

Bereavement

6 months

1 2 3 5

The North West End of Life Care Model

4

Death

Increasing decline

‘Rapid Discharge Pathway’

(RDP)Advance Care Planning

‘Preferred Priorities for Care’

‘Gold Standards Framework’ (GSF)

End of Life CareTools

Adapted from The North West End of Life Care Model, Healthier Horizons for the North West, NHS North West (May 2008)

GSF Coding of Residents in the Care HomeGSF Coding of Residents in the Care Home

Years Years to Liveto Live

• Advance Care Plan discussion initiated.Advance Care Plan discussion initiated.• Holistic assessment Holistic assessment

Months Months to Liveto Live

• Advance Care Plan in place. Advance Care Plan in place. • Holistic assessment. Holistic assessment.

Weeks Weeks to Liveto Live

• GSF Out of Hours Handover Form GSF Out of Hours Handover Form • Family discussionFamily discussion• Pre emptive prescribingPre emptive prescribing• GP assessmentGP assessment

Days to Days to LiveLive

• Liverpool Care Pathway commenced by Liverpool Care Pathway commenced by

Multi-disciplinary decision Multi-disciplinary decision • Daily Daily GSF Out of Hours Handover Form

AA

BB

CC

DD

GSF: The 7 Key Tasks (7 Cs)GSF: The 7 Key Tasks (7 Cs) C1 Communication

Supportive Care Register, regular meetings. Advanced care planning.

C2 Co-ordinationNamed leads to co-ordinate. Effective team-working and collaboration.

C3 Control of SymptomsAssessment tools, guidelines, Specialist Palliative Care Team (SPCT)

C4 Continuity Handover form, Out Of Hours protocol, liaison

C5 Continued LearningContinued learning in practice

C6 Carer SupportPractical, emotional, bereavement

C7 Care in dying phase Liverpool Care Pathway for the Dying Patient (LCP)

The GSF Care Homes The GSF Care Homes Training Programme Training Programme

Goals1.To improve the quality of end of life

care

2. To improve collaboration with primary care and palliative care specialists

3. To reduce hospitalisation- and enable more to live and die at home

What’s in it for the What’s in it for the staff?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.

What's in it for residents?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

20 Key standards- 20 Key standards- Accreditation checklist Accreditation checklist

1. Leadership + support2. Team-working3. Documentation4. Planning meetings5. GP Collaboration6. Advance Care

Planning7. Symptom control8. Reduce

hospitalisation9. DNAR +VoD policies10. Out of hours continuity

11. Anticipatory prescribing12. Reflective practice+

audit13. Education + training14. Relatives15.Care in final days16. Bereavement17. Dignity18. Dementia19. Spiritual care20. Sustainability