REACHING OUT TO DEVELOP QUALITY PALLIATIVE CARE IN CARE HOMES: DATA FROM A 7-YEAR PROJECT

A fifth of the UK population dies in a nursing home (care home). In 2008, the Department of Health’s end of life care strategy encouraged the implementation of specific palliative systems to all settings. St Christopher’s Hospice, London became a regional centre for the Gold Standards Framework in Care Homes programme (GSFCH) to reach out to care homes to improve the quality of palliative care. We implemented and audited the GSFCH in nursing care homes across 5 clinical commissioning groups (population of 1.4 million people) over a 7-year period using a research-based model of facilitation. Across 76 nursing care homes, the percentage of residents dying in hospital reduced from 43% to 21% with an increase in documentation of advance care planning and cardio-pulmonary resuscitation decisions. A ‘high’ facilitation model, including a sustainability initiative and ongoing audit, contributed to significant improvements. Reciprocity and trustworthiness underpin the success of this initiative.