Date: 16 March 2015
The final days of life are very important. For people with advanced illness or frailty the type of care they receive and where they receive it has an enormous impact on their experience. It creates long lasting memories for their loved ones too – positive and negative. St Christopher's Bromley Care Coordination Service (BCC) is rising to the challenge of making sure people can spend their final days in the place of their choice which is usually at home.
The team cares for people in their own homes and supports family members and carers so they can make decisions that reflect patients' preferences. It's just one of the ways NHS Bromley Clinical Commissioning Group is investing in services that make a real impact on older people and their carers and families.
Dr Mandy Selby, GP and Clinical Lead at NHS Bromley CCG said, "Most of the patients who are referred to the service are elderly and need to be registered with a Bromley GP and thought to be living in their final year. The service has been specifically designed to pick up individuals who normally would not be referred for specialist palliative care."
The Bromley Care Coordination service is staffed by nurses who have a wide range of experience spanning heart failure, dementia, respiratory disease, and palliative care. The service operates from the St Christopher's Bromley site in Orpington and receives management support from St Christopher's.
It has now been operating for a year and was short listed for a Health Service Journal award. It recently won a Hospice UK Innovation award and users of the service have been giving it high praise:
"My GP discussed this new service with me and I was very happy for my mother to be referred. The first visit was lovely. It put a new emphasis on the care for my mother and showed me that it was no longer just about the practical matters but she allowed me to see this time as a truly special time with my mother. It was amazing really. I know I wouldn't have been able to do that on my own. This service has given me huge confidence that I can cope and I can care for my mother at home knowing that I have back up 24 hours a day." - Cecilia Willatt, carer for her mother Dorothy, aged 94 who has Parkinson's disease
What happens once Bromley Care Coordination steps in?
Mr A (75 years old with an end stage neurological disease and dementia) was referred by his GP as his condition was deteriorating. He was unable to get out of bed and his cognitive function was declining. His wife was his main carer and she was exhausted.
Mr A had a once a day visit from a domiciliary care agency to help with his morning care. When the BCC nurse first visited, Mrs A was asking for her husband to be admitted to hospital as she felt she could no longer manage. After assessing the situation and listening to Mrs A, it became clear that the request for a hospital admission had come out of desperation and distress. What she really wanted to be able to do was to care for her husband at home until his death but she was frightened and needed more help and support.
What does the nurse do?
1. The nurse made an assessment of Mr A's continuing health care needs and applied for funding under the fast track rules for an immediate increase in the package of care.
2. Further assessment and adaptations were needed to the home to enable Mr A to be moved more easily and safely. The BCC nurse held discussions with the integrated health team and social services to clarify.
3. Some adjustments to Mr A's medicines were needed for better pain control.
4. The discussions about Mr A's preferred place of care were communicated, with consent, to other professionals via the Coordinate my Care register. The BCC nurse also ascertained that should Mr A's heart stop from a sudden heart attack it would not be in his best interest to be resuscitated. This information was also communicated to other professionals, in particular the ambulance service. Further discussion took place about other possible situations and how these could be managed at home, eg an infection.
5. A referral was made to the district nursing service as Mr A's condition was deteriorating.
6. Most importantly, the BCC nurse listened to Mrs A's anxieties and gave her information on what to expect as death approaches. An emergency box of medications was delivered to the house so that the staff caring for Mr A could act to alleviate Mr A's symptoms quickly day or night.
3. For more information contact the media team at NHS Bromley CCG on 020 3049 3333.
Bromley Care Coordination is staffed by nurses who have a wide range of experience spanning heart failure, dementia, respiratory disease, and palliative care. The service operates from the St Christopher's Bromley site in Orpington and receives management support from St Christopher's.