1. Jan Aimer Project Lead Acting Head of Practice and Professional Development CHP’S Fife/ Macmillan Cancer and Palliative Care Educator SUPPORTING PALLIATIVE CARE IN CARE HOMES ‘Fife’s Educational Care Home Project’ Phase 1 and 2 FIFE

2. Aim of the Project That General Palliative Care practice in care homes is enhanced and developed by an educational strategy and consistent programme of knowledge and skills. That acquired and enhanced skills and knowledge in general palliative care are implemented into practice. That Care Homes have formal links to specialist palliative care resources enabling advice: support and planning of care management for residents and carers.

3. Why we started the project 5% >65years reside in care homes 1 in 5 deaths takes place in this setting. 52% of all care homes are for older people (908) (Scottish Care Commission, 2004). Forecast population of elderly will continue to rise well into the 21st Century. Care homes for older people have the highest incidences of failing to meet regulations (Scottish Care Commission, 2004). Good quality of end of life care must be recognised as a basic human right (WHO, 2002). Department of Health Improving Care Improving Lives (2005). Supporting People with Long Term Conditions (2005) Joined up thinking Joined up Care (2006) The Future Care of Older People in Scotland (Scottish Executive 2006) Making Good Care Better (2006) National Practice Statements for General Palliative Care in adult Care Homes in Scotland.  Sparra Scottish Patients at Risk of Re-Admission and Admission (June 2006) Better Health Better Care (2008). Living and Dying Well (2008).

4. Practice Educator’s Role in the Project Education Clinical Consultancy Leadership Research Audit

5. Palliative Care Education Facilitator’s Role in the Project ‘ The facilitators role is concerned with enabling the development of reflective learning by helping to identify learner needs, guide group processes, encourage critical thinking, and assess the achievement of learning goals’ Harvey et al, 2002 ) Libby and Heather’s Role is to Enable cultural changes & challenging current ways of working, utilizing reflection as a learning tool.

6. What is it about……. Role model / Effective relationships Supportive learning environment Ownership / Realistic Outcomes Professionalism / Trust / Respect Good Communication / Clear direction Innovation / Motivation Up-to-date knowledge Team building/ People / Friendship Recognition of others skills & abilities Having vision, enthusiasm & commitment Receptive to new ideas

7. Projects Strategic Objectives Identify care homes interested in Project. Roles people play Competencies Changes to take place Identification of Training/ Development Needs Clearly articulated and expressed in measurable terms and objectives/outcomes Training Plans Agreed Education External HCI Provided Education= Trust/in-House programmes Appraisals TNA Service Development Critical Incidents Patients expectations feedback complaints

8. Tool Used in Project Preferred Method Of Delivery Train the Trainers Model ‘Key Champions’ in Palliative Care from each care home Macmillan Foundations in Palliative Care A programme of Facilitated Learning for Care-home Staff

9. Challenges CCollaboration/Communication HHealthcare Professionals AAchieving our project goals LLeadership LLearning Environment EEducational Opportunities NNursing practice/clinical focus GGovernment Issues EEvaluation

10. Challenges in Practice  Resources Staffing Levels /financial implications  Annual Leave  Sickness  Mandatory Training overwhelming  Shift Patterns  Family Commitments  Attendance in own time  Recruitment and retention problems  Resistance to change  Low motivation/low morale  Undervalued

11. Recommendations from First Cohort to resolve some of the barriers faced Involve the Manager more in tightening the Inclusion criteria for key champion so that we do not loose them initially Deliver the programme over 3.5.days

12. Participants Comments Registered Nurse Understanding models of grief and bereavement have given me a better view of how the client and those related to the client and also those who care for the client may feel or react. The models of pain and the breakthrough of pain were most helpful and I will integrate these into my work as a nurse as a more effective strategy of dealing with pain. Also discussing the nature of relationships between the dying patient, staff and family has made me think more on the emotional side of my job which is something I think most nurses tend to become quite clinical about. This course has made me think more about how much more comfortable we can make the final months, hours, days or years for the dying client and how effective a more structured team orientated approach can be.” Support Worker “Since doing the palliative care course it has opened my eyes to many things. It has made me understand the needs of the elderly a lot better, also levels of pain and how you can help them in many ways medically and emotionally. Helping relatives through their grief and sometimes a cuddle say’s much more than words. Helping each other as well, as grief can affect people in many different ways.”

13. ADVANTAGES OF HAVING INPUT FROM THE EDUCATION TEAM Offers opportunities to gain knowledge and skills to both registered and non-registered staff with the aim to influence clinical practice and improve patient care. Palliative care needs tailored to each individual care homes Professional development and continuing learning opportunities Consultancy basis Educational remit Key Link person for Care Homes for practice development opportunities in NHS Fife

14. Benefits for the Care Home and the Older Person

16. VISION FOR THE FUTURE Living and Dying Well (2008) Phase 2 Improve People’s Quality of Life with end of life issues. Address the inequality of care of the older person Adopt an innovative approach to education and develop good communication channels across the boundaries of NHS and the Private Sector. Empower staff to become competent, reliable and trustworthy people in dealing with palliative care and end of life issues. Collaborative and shared working. Continued evaluation