1. National Homecare Conference Anne Willis Hospice Manager : Marie Curie Hospice : Edinburgh.

2. The Role of Hospice Care. What do Hospices do? What do Hospices do? Current challenges for Hospices. Current challenges for Hospices. The role of Hospices in end of life care at Home. The role of Hospices in end of life care at Home.

3. Hospices World Wide. Now 7,000 Hospices in over 90 countries. In Europe largest number are in Poland 246, France, Germany and Sweden. In Scotland 19 Adult Hospices, 2 Childrens Hospices. 13 are independent voluntary organisations supported by their local communities. Health Boards provide £13 million. 40% of Hospice Running Costs. All Hospice care is Free.

4. The Hospice Movement. Started with Dame Cicely Saunders who founded the first Hospice in the UK. Started with Dame Cicely Saunders who founded the first Hospice in the UK. Dedicated to patients with cancer and the concept of ‘What is in your mind and in your heart’, Dedicated to patients with cancer and the concept of ‘What is in your mind and in your heart’,

5. What is the aim of a Hospice ? Optimise quality of life before a timely, dignified and peaceful death. Optimise quality of life before a timely, dignified and peaceful death. A place for comfort, care and support. A place for comfort, care and support. Lead and Influence the development of palliative care services locally and nationally. Scottish Government Action Plan : Living and Dying Well. Lead and Influence the development of palliative care services locally and nationally. Scottish Government Action Plan : Living and Dying Well. A local resource, supported by the community. A local resource, supported by the community.

6. REFERRAL REFERRAL Patients with advanced, progressive or incurable disease who need palliative care. Patients with advanced, progressive or incurable disease who need palliative care. Patients in any setting, home, hospital or care home. Patients in any setting, home, hospital or care home. Telephone advice, a single assessment or a period of specialist care. Telephone advice, a single assessment or a period of specialist care. Referral for any patient who has complex end of life symptoms, uncontrolled pain or other symptoms, complex, physical, psychological, spiritual or family needs that cannot be met by the existing team. Referral for any patient who has complex end of life symptoms, uncontrolled pain or other symptoms, complex, physical, psychological, spiritual or family needs that cannot be met by the existing team. Palliative Care Guidelines Palliative Care Guidelines Any health professional in discussion with GP Any health professional in discussion with GP

7. The Challenges. The Challenges. Services in last weeks or months of life. Services in last weeks or months of life. Associated with dying limits acceptability. Associated with dying limits acceptability. Resource constraints. Resource constraints. 8,000 each year 8,000 each year ¼ cancer ¼ cancer 1/3 dementia/frailty 1/3 dementia/frailty 1/3 organ failure 1/3 organ failure 1/12 sudden 1/12 sudden >50% in hospital >50% in hospital

8. Activity Tells a Story. 07-0808-09 Admissions394456 Discharges215228 Deaths326362 CNS Visits at Home. 23722561

9. Cancer Care : Inpatient Care “After eight days, I was able to return home,and my wife and I went on holiday up to the north of Scotland. Sitting next to beautiful Loch Linnhe, we felt so relaxed, and had a lovely week.” “After eight days, I was able to return home,and my wife and I went on holiday up to the north of Scotland. Sitting next to beautiful Loch Linnhe, we felt so relaxed, and had a lovely week.”

10. Social and Psychological Support: Day and Outpatient Services. ‘ I take one step forward and then two steps back ‘ ‘ I take one step forward and then two steps back ‘ I’d like to get better, but I keep getting a bit worse. I’d like to get better, but I keep getting a bit worse.

11. Comradeship We are all in this together, so lets talk about it. We are all in this together, so lets talk about it. Psychological and spiritual support. Psychological and spiritual support. Skype/ Blogging your cancer friends.Linking to Maggies Centre. Skype/ Blogging your cancer friends.Linking to Maggies Centre.

12. Comfort for Carers. Complementary therapies for carers and patients. Complementary therapies for carers and patients. Support for Carers at Home,- respite and befriending. Support for Carers at Home,- respite and befriending. Palliative care workshops with VOCAL Palliative care workshops with VOCAL

13. Hospice in the Community Raising awareness about death, dying and grief. Raising awareness about death, dying and grief. Bereavement care. Bereavement care. Involving and engaging with local organisations. Involving and engaging with local organisations.

14. Frailty and Dementia Focus on Care Homes. Advanced care plans even earlier. Advanced care plans even earlier. Pain Assessments Pain Assessments Education. Education. EOL conversations. EOL conversations.

15. The Role of Hospices : End of Life Care at Home Working with GP ‘s to review Palliative Care Registers. Advice and Review of Specific patients at home or in Outpatients. Carers Support. Clinical systems development.LCP, DNAR, Pain Assessment, OOH Communication. Allocated Care Homes, end of life care planning, education and modelling of best practice.

16. Aiming to Equip Other Professionals Better assessment and management of pain. Better assessment and management of pain. Importance of advanced care planning versus ‘ striving to keep alive’ Importance of advanced care planning versus ‘ striving to keep alive’ Recognising dying,- taking responsibility and promoting importance of end of life decision making. Recognising dying,- taking responsibility and promoting importance of end of life decision making. Promoting an outlook on death and expectations which relate to reality to prevent unnecessary admissions or aggressive treatments. Promoting an outlook on death and expectations which relate to reality to prevent unnecessary admissions or aggressive treatments.

18. References. Philp I ( 2003) End of Life Care for Older People. European Journal of Palliative care,10 (4) : 151-153. Philp I ( 2003) End of Life Care for Older People. European Journal of Palliative care,10 (4) : 151-153. www.mariecurie.org.uk/dementiaproject2009. www.mariecurie.org.uk/dementiaproject2009. www.mariecurie.org.uk/dementia http://www.scotland.gov.ukliving and dyingwell http://www.scotland.gov.ukliving and dyingwell http://www.scotland.gov.ukliving