Improving end of life care in Care Homes: findings from an evaluative research project
Authors: Scammell, J.
Conference: Networking for Education in Healthcare Conference
Dates: 3-6 September 2012
Abstract:Health care policy in the United Kingdom is orientated towards promoting shorter acute hospital stays and more care at home, including end of life care (Gomes et al, 2012). With the increase in life expectancy and the decline in extended families, for many people ‘home’ will mean a Care Home. However suboptimal end of life care in care homes has been reported and this may result from inadequate staff education (DOH 2008). Training is complex as palliative care derived from a cancer care model may not be directly transferable to those dying in care homes. It is important therefore to work closely with care home staff to ensure that education is not only tailored to their situation but is also sustainable.
This paper will present the findings from a two-year evaluative research project that commenced in February 2011. The focus concerns the outcomes related to an innovative educational programme using an action-learning model developed for care home leaders. The project aims to improve End of Life Care (EoLC) in selected care homes through education of care home leaders and to develop a sustainable educational model for wider use. Alongside implementation, an independent service evaluation of programme outcomes is being conducted.
In 2009-10 a hospice in the south of England, in collaboration with an independent action-learning facilitator, implemented a successful pilot programme for care home operational leaders. The pilot revealed that it takes more than a good knowledge and understanding of EoLC to positively impact on practice. Care home managers also need highly developed levels of interpersonal skills and management expertise to be able cascade this knowledge to front-line staff and to embed these standards within day-to-day care. Effective leadership skills are required to ensure changes in practice are sustained in the care home environment and developed in conjunction with multi-disciplinary and multi-agency partners such as general practitioners and district nurses. A grant from The Frances and Augustus Newman Foundation has enabled the team to extend and develop the model further as well to engage in a rigorous evaluation process; the results are the focus of this paper. Operational leaders (n=8) from different care homes were recruited to undertake the Action Learning End of Life Care Development Programme. The programme comprises 10 study days over one year. Using a summative evaluation approach (Urban and Trochim, 2009), an independent evaluation involving mixed methods is being undertaken. This includes a pre and post comparison of training needs, a self-assessed survey of confidence in terms of EoLC, a content analysis of participants’ self-assessment against EoLC competencies (DOH, 2009), plus focus groups immediately post-programme and six months later. In addition self-assessed confidence data is also being collected from care home staff (n=37). At the time of writing the pre-programme data has been collected and the programme is almost complete. Post programme data will be collected shortly. The paper will draw upon the subsequent analysis and present the findings. Lessons learned from the evaluation of this educational model, could be used to inform EoLC education to the care home sector more widely.
References Department of Health (2008). End of Life Care Strategy. London: HMSO Department of Health (2009). Core competences and principles for health and social care workers working with adults at the end of life. London: HMSO Gomes, B., Calanzani, N., Higginson, I. (2012). Reversal of the British trends in place of death: Time series analysis 2004-2010. Palliative Medicine: published online 18 January 2012. Available from: http://www.endoflifecareforadults.nhs.uk/assets/downloads/Palliat_Med_2012_Gomes_0269216311432329.pdf [Accessed 23/1/12]
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