Ask Glaswegians about palliative care and many would pay testament to the superb specialist hospices and palliative services within the city, and the care and support received at the end of a loved one’s life.
There are also a host of community staff; dedicated, experienced individuals working along-side specialist services to support the palliative and end of life needs of its population.
But palliative care is not just required at end of life. Many Glaswegians are living with long-term, life-limiting conditions which require on-going care and support within their own home.
Life expectancy in Glasgow is lower than the national average.
You are more likely to die from cancer, smoking-related diseases, heart disease or be hospitalised with COPD.
It’s vital we do all we can to identify those who would benefit from palliative care and ensure that support is available to allow them to live and die well.
My role is to support the testing of ways to improve how we do this, and help share the story of that improvement with others.
With support from Healthcare Improvement Scotland, I hope to work with colleagues and partners to evidence an improvement in identification of palliative care need and care co-ordination.
Glasgow has the largest care home population of any local authority in Scotland and some of the improvement work will focus on the residents of these homes.
The needs of this population are complex. Finding ways of listening to their preferences and supporting them to receive care in what for them is their home may be a challenge, but a worthwhile one.
I believe that improving identification of their needs and wishes, monitoring and planning for change and improving communication with the wider care team will support us to provide person-centred care in the correct setting.
Although care homes are a focus I would welcome any thoughts or ideas for improving identification or care co-ordination for any care group within the community. Please get in touch.
I’ve been a registered nurse for 28 years, starting my career in Northern Ireland. I moved to community nursing in 1996. It was during this time I worked with Marie Curie Nursing Service in Northern Ireland.
I developed a passion for palliative care and worked mainly night-duty, caring for people in their homes and supporting their family.
This work prepared me for the expected loss when my mother died. As many people do, I helped care for her in her own home, where she died with her family around her in March 1999.
I saw first hand the support needed by different members of a grieving family, and what her death meant to them.
In 2001 we moved, with a young family, to South West Scotland and settled in a lovely farm over-looking the sea. I joined NHS Ayrshire & Arran and since then I’ve been supported to work and study caring for people with cancer and palliative care to degree and masters level.
Shortly after our move, my father died suddenly and unexpectedly. This opened up a different perspective on death, which I wasn’t as prepared for.
His death made me realise that there are different reactions to the ways in which people die, and the support needed in the weeks and months after is often different.
These experiences, and what I learned from them, remain with me.
A recent thesis study explored the knowledge and skills required by family members to look after someone who was palliative at home. This was another window into the support needed by families to use equipment, move people and general knowledge for managing medicines.
My interest remains in caring for the individual and their family during this distressing time, when people are often at their most vulnerable.
My aim is that the person can die peacefully in a place of their choosing, and their family will feel supported and cared for while caring for their loved one.
I’ll update you soon on the work I’ve been involved in around palliative beds in care homes.
Sadie, a resident at Thomson Court Care Home in Bute, is playing hoopla, and is determined to score. Sitting on either side of her are some children from the local nursery, cheering her on: “Go Sadie!”
This was just a normal Wednesday afternoon at Thomson Court, where the residents had regular visits from the children at nearby Apple Tree Nursery.
Inspired by the example of a care home in Canada that had co-located a staff nursery to increase resident contact with children, Sheila Scott, who was the Unit Manager at the care home, wondered if there was the potential to do something similar at Thomson Court. Sheila had noticed that many residents in the home were not seeing their great-grandchildren on the mainland, and Appletree Nursery, where her daughter Stephanie works, is very proactive in working with the community.
Getting the ball rolling
The children first visited the care home in summer 2015, when they helped to paint the fence and planted sunflower and lettuce seeds. ‘Cameron’s Auntie Nan and her friend Sadie made sure that we painted it all,’ reads one of the quotations from the day. The initiative was such a success that it led to a regular programme of indoor and outdoor activities between the care home residents and the children.
The nursery staff compiled a floor plan with photographs and feedback from all their sessions, which map activities to health and wellbeing outcomes to demonstrate their beneficial impact.
Looking back over the years, it is inspiring to see the breadth and variety of activities that have taken place in the care home: ‘dooking’ for apples at Halloween, music and movement sessions, baking and biscuit decorating, puppets and nursery rhymes, and a raspberry tea, to name but a few. At Christmas the children made gifts for the residents and table mats for their Christmas dinner, and Santa came to visit them all. The children also made cards for the residents for Valentine’s Day and Mother’s Day, and there are plans for the residents to attend a concert at the nursery this Christmas.
The nursery also helped to raise money to pay for resources that support the residents’ wellbeing. They held a bake sale, which raised enough money to pay for a therapy doll for a resident who has dementia, and the children helped to choose the doll that was purchased. They also raised funds for a material cat and a pram, which are calming for residents.
Benefits for young and old alike
The nursery and care home staff observed that the intergenerational activities have had a positive impact on both the residents and the nursery children. Sheila commented that the Wednesday sessions provided a good break for residents in the afternoon. The residents were able to choose whether or not to attend, and one resident who initially was not interested in joining in the activities because he has a lot of family of his own living locally started to come along when he saw how much fun everyone was having! The daughter of one of the residents commented that the children ‘generally light the place up’, and that both the residents and the children loved it.
Lesley-Anne Lee, the nursery manager, observed that ‘our weekly visit to our Thomson friends has given the children new experiences and emotions’ and they appreciate that the residents were teaching the children ‘maybe without them realising’. She also commented that ‘the bond between the vast age differences is a joy to see.’
The nursery children forged close friendships with the residents, and one of the nursery pupils, Maisie, who is now at primary school, formed a particularly close bond with Barbara, and enjoyed painting her fingernails. ‘Barbara is my friend, she’s my best girl,’ she said, and her father observed that ‘Maisie loves Thomson Court.’
Learning about life
The regular visits made the children more aware of disabilities, and helped them to learn about the whole of life, including its end. The children visited one of the residents’ rooms to look at old photographs and learn about what her life was like when she was younger, and they also started a memory garden at the nursery to commemorate residents who had passed away.
Sheila observed that most of the residents have dementia, which affects their ability to communicate, and that the children helped to bring them out of their shell. One resident, who previously did not talk very much, became very animated when the children visited.
After an hour packed with games, and a break for cake and juice, it was time for the children to head back to the nursery school. ‘I want to stay at Thomson Court because it’s so much fun,’ pipes up one of the children. Thanks to the hard work and commitment of the staff at both the nursery and the care home, it was easy to understand why they did not want to leave.
Our intermediate care and reablement event took place at 200 St Vincent Street on 21st March 2017 and shared findings from our intermediate care scoping work, and learning from services across Scotland. The event was supported by the Scottish Government, Social Work Scotland and the Health and Social Care Benchmarking Network.
By Laura Dobie, Knowledge and Information Skills Specialist, Healthcare Improvement Scotland
On 5th December I went along to the Argyll and Bute Care Homes Quality Improvement for Falls Prevention event. It was a really interesting day, and it was great to hear about the work that care home staff are doing to reduce falls and improve quality of life for their residents.
PDSAs and data
Dr Christine McArthur, Project Lead, introduced the day and Sheila Morris, Occupational Therapy Care Home Lead, gave an overview of Plan Do Study Act cycles and the role of data in improvement. She emphasised the importance of carrying out small tests of change and having a clear plan.
The project participants then had the opportunity to discuss a case study of a 72-year-old lady who had had a number of falls, considering risk factors such as polypharmacy and multiple complex conditions, and reviewing the data in the falls diary to identify whether there was a pattern to her falls.
By Laura Dobie, Knowledge and Information Skills Specialist, Healthcare Improvement Scotland
Argyll and Bute Health and Social Care partnership has been holding a series of quality improvement workshops for care home staff, in collaboration with Scottish Care. I went along to one of their workshops with care home staff in Dunoon on 10th May to find out more about the work that the partnership is doing with care homes.
All 20 care homes in Argyll and Bute are signed up to a quality improvement project to reduce falls. Funded by the Integrated Care Fund, and supported by health professionals in each locality, the project aims to support care home staff to address falls risks in their care home. A particular emphasis is on improving physical activity for health and wellbeing.
The quality improvement workshops
Dr Christine McArthur, NHS Highland Coordinator Prevention and Management of Falls, Jane Howe, Quality Improvement Manager, and Kirsty Brown, Assistant Practitioner (Physiotherapy), facilitated the workshops. The team worked collaboratively with Scottish Care to develop events which met the needs of care home staff. The care homes requested a series of smaller local workshops, rather than one big event, as some staff do not drive and it was easier them to attend local events.
The Living well with Frailty event, held at Heriot-Watt University in Edinburgh on the 27th of October brought together colleagues from across the health and social care sector to undertake a deep dive into the issues surrounding frailty.
The day comprised morning and afternoon plenaries, as well as eight breakout sessions ranging from ‘A focus on Dementia – personal outcomes in practice?’ to ‘Care Homes: My care, Your care, Our care – Designing a Care Home for the future’. For a full list of the sessions please download a copy of the agendafrom the day. A comprehensive overview of each of the sessions is available below.
Breakout sessions Timely identification and co-ordination of care for older people living with frailty Presenters: Penny Bond and Karen Goudie
During this workshop, Karen and Penny from Healthcare Improvement Scotland led a discussion with attendees on what it means to be an older person with frailty going through our hospital system. Brief patient stories were shared to highlight opportunities and challenges as a starting point for discussion. Attendees then shared experience of testing and implementing different approaches to identifying and coordinating frailty care within acute care settings. The timely identification and co-ordination of care for older people living with frailty presentation can be viewed via the following link and you can watch a video of Mrs Andrews’ story on YouTube below.