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The Bromhead Boston Care Home Support Service. Gill Garden Pilgrim Hospital Background. > 200 admissions from care homes to ULH during 3 week period in November 2009 January 2010: Chance meeting member of local charity workshop Discussion with Trust HQ & with PCG

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the bromhead boston care home support service

The Bromhead Boston Care Home Support Service

Gill Garden

Pilgrim Hospital



  • > 200 admissions from care homes to ULH during 3 week period in November 2009
  • January 2010: Chance meeting member of local charity workshop
  • Discussion with Trust HQ & with PCG
  • March 2010: Business case presented to charity
  • Funding for two year care home pilot secured

Care Home Liaison Service Proposed

  • 8 care homes (274 places) in Boston
  • Staffing
    • 2 WTE staff (bands 7&6)
    • Support from Liaison Psychiatrist (in post)
  • Phased introduction:
    • Identification of residents with dementia
    • Training of care home staff
    • Care planning
    • Outreach service:
      • To assess & advise whether treatment can be instituted at home or admission required
      • To advise re institution of palliative care


  • Agreement secured: CCG, GPs & care homes
  • Background information drawn up
    • GPs, care home, carers’ letters
    • Information leaflets: delirium, feeding, end of life care
    • Educational programme devised
  • Register of residents with dementia
    • Care home data
    • GP dementia registers

Education in Care Homes

  • Stop Delirium! *
    • Delirium information given to care homes
    • Education sessions delivered in care homes
    • Effectiveness measured by pre/post education surveys
  • Dysphagia & comfort feeding
    • Teaching package developed with speech & language therapists
    • Comfort feeding leaflet given to care homes

*University of Leeds 2007


Gold Standard Framework (GSF) Prognostic Indicator Guidance

  • Unable to walk without assistance and
  • Urinary & faecal incontinence and
  • No consistently meaningful conversation and
  • Unable to do activities of daily living and
  • Barthel score <3

Plus any one of following

  • Weight loss & reduced oral intake
    • 10% weight loss in 6/12 without other cause
    • Albumin <25 g/l
  • Aspiration pneumonia
  • Recurrent fever, pyelonephritis or UTI
  • Severe pressure sores (grade III/IV)

Individual Resident Assessment

Presence of dementia/suspected dementia

  • Nutrition: MUST
  • ADLs: Barthel
  • Waterlow
  • Cognitive assessment

Advance Care Planning

  • Most frail & dependent prioritised
  • Mental Capacity Assessment
  • Advance Care planning:
    • families approached by care home staff
    • undertaken on best interests basis
    • meetings involve:
      • Staff, family/close friends or those with POA
      • History, current health, prognosis & end of life care discussed
      • Liaison Psychiatrist only for residents without next of kin (IMCA requested but declined)

Implementation of

Advance Care Plans (ACP)

  • ACP sent to care home, GP, ambulance & out of hours services
  • DNACPR forms completed by care home liaison nurses & endorsed by GP
  • Care homes receive frequent support & guidance in the practicalities of using the ACP
  • 30 residents have died in their preferred place of care because an ACP was in place

Carer Satisfaction

  • After completion of ACP carers asked to complete anonymous satisfaction questionnaire
  • Results evaluated using Survey Monkey providing quantitative and qualitative data
  • Very positive feedback: 92.6% of respondents rated the service 9/10 or 10/10

“Found the nurse to be very helpful in her explanations of all questions I asked. All was put in a very easy to understand way. I think this idea of advanced planning is very good, & allows relatives input into their family members care instead of being made to feel it is nothing to do with you”

Carer Satisfaction

“Excellent service”

“My mum had made a living will & it was something she always talked about with her family, this process has given me the confidence to know my mum’s “voice” will be heard even though she can no longer communicate effectively. As a family we also feel we have been given the opportunity to be “heard” for the first time”

“I met with the nurse & although I understood what an advanced care plan was I found it comforting to discuss the details with a nurse who showed so much empathy & understanding. If I have any queries in the future I wouldn’t hesitate to contact the nurse knowing that she would find time to talk to me without judging”


Future Plans

  • Advance care planning for all inpatients (existing or future care home residents)
  • Involvement of hospital staff in care planning
  • Expansion of inclusion criteria to include frailty
  • Expand geographic area & thus number of people offered this service
  • To secure permanent funding