1. Sharon Cansdale GSF Facilitator
Gold Standards Framework for Care Homes (GSFCH) Programme
Sharon Cansdale
GSF
Facilitator

2. Why do we need to develop 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
The EOL care Stratagy board tells us that whilst it has become the expected norm for people to be admitted to hospital to die, at the turn of the century 90% of people died at home and that now people have lost familiarity with death and do not know what to expect. The paper advises that there is a need to ensure good quality eol care in all settings. This would help to avoid unnecessary hospital admission. They state that we are in a crucial stage in demograpic change in our country and that we have a short window of opportunity before 2012 when the number of people dying in this country increases dramatically. With the eol strategy gsf are working closely together to get this right.
Need to build upon the excellent care which is provided in the care homes to improve the quality of care and the coordination across the multi disciplinary team.
unnecessary hospital admission. At present approx 58% people die in hospital. Whereas most people would prefer to die at home amongst loved ones and familiar faces and surroundings..
As they are increasingly important as locations of care for older people.

3. ‘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.
For many people a good death would involve;
Some people do die as they wish, experiencing excellent care in hospitals,hospices,care homes and at home, but the reaLITY IS THAT MANY DO NOT, EXPERIENCING PAIN AND OTHER DISTRESSING SYMPTOMS IN A PLACE THAT IS NOT OF THEIR CHOICE AND WITHOUT DIGNITY AND RESPECT

4. Findings 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.

5. What is the Gold Standards 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
Identifying the patients who are approaching end of life, planning in advance for their end of life so that strategies for coping with that can be set in place. Alleviate pain and suffering by controlling symptoms as they arise and ensuring that the patients wishes are documented respected and acted upon and ensuring dignity and respect for the person.
Communication across the multi disciplinary health care team is essential, GSF is an ongoing process which should standardise care, ‘all singing from the same hymn sheet.’

6. The GSF 3 Processes 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
3. Plan
Communicate
2. Assess
Communicate
1. Identify
Communicate

7. Stage III Consolidation + Sustainability
3 stage training programme Preparation, training, consolidation + 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
 
     
ADA
After
Before
Final
Appraisal
Ongoing ADA
Enrolment of Care Homes
Preparation pack
Watching DVD describing programme. Support from senior staff, owners and managers. Support from facilitator,
Collaboration, discussion from GPs, link with specialist palliative care teams.
Consultation and comunication with families and residents.
Baseline measurements ADA after death analysis audit.
Competency self assessment. Teamworking.
Training programme. Setting up and coding. Advance Care planning Cross boundry working - Ooh service ambulance service.
Reducing hospitalisation, DNAR verification of death allow natural death living wills. Rapid discharge policys developing policys for these items. Communication and collaboration is the main theme
Attendance at four local training workshops, attending teaching sessions. Building knowledge and skills. Local coordinators meeting, sharing knowledge and ideas. Feedback
Accreditation from national team.
Ada
ADAs, self assessment, appraisal visit.
Stronger links with palliative care teams, better collaboration. Local education.

8. The North West End of Life Care Model
‘Liverpool Care Pathway for the Dying’ (LCP)
Last Days of Life
First Days after Death
1 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 Care
Tools
Identify those who may be in the last year of life and which stage they are at, enabling you to identify their needs and wishes at an earlier stage so that the planning of care can take place.
Communication acroos the team to ensure that patients needs are met in last days, ie symptom control, minimising chances of crisis occurancance which may lead to hospitalisation.
Care for the bereaved after death of the patient.
Adapted from The North West End of Life Care Model, Healthier Horizons for the North West, NHS North West (May 2008)

9. GSF Coding of Residents in the Care Home
Years to Live
Advance Care Plan discussion initiated.
Holistic assessment
Months to Live
Advance Care Plan in place.
Holistic assessment.
Weeks to Live
GSF Out of Hours Handover Form
Family discussion
Pre emptive prescribing
GP assessment
Days to Live
Liverpool Care Pathway commenced by
Multi-disciplinary decision
Daily GSF Out of Hours Handover Form A B C D

10. GSF: The 7 Key Tasks (7 Cs) C1 Communication
C5 Continued Learning
Continued learning in practice
C6 Carer Support
Practical, emotional, bereavement
C7 Care in dying phase
Liverpool Care Pathway for the Dying Patient (LCP)
C1 Communication
Supportive Care Register, regular meetings. Advanced care planning.
C2 Co-ordination
Named leads to co-ordinate. Effective team-working and collaboration.
C3 Control of Symptoms
Assessment tools, guidelines, Specialist Palliative Care Team (SPCT)
C4 Continuity
Handover form, Out Of Hours protocol, liaison

11. The GSF Care Homes Training Programme
Goals
1.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

12. What’s in it for the 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.

13. 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

14. 20 Key standards- Accreditation checklist
Leadership + support
Team-working
Documentation
Planning meetings
GP Collaboration
Advance Care Planning
Symptom control
Reduce hospitalisation
DNAR +VoD policies
Out of hours continuity
Anticipatory prescribing
Reflective practice+ audit
Education + training
Relatives
Care in final days
Bereavement
Dignity
Dementia
Spiritual care
Sustainability
In red are key standards which cannot be accepted as working towards and need to be fully achieved
5 agreed means of effective collaboration with GP practice.
6 discussion if offered and recorded for all residents
8 reduce avoidable or inappropriate hospital admission length of stay – evidence of measures in place such as policy, training.