Improving end of life care: supporting the workforce and reducing hospitalisations through an implementation study in care homes

Over 50% of people in nursing homes and 26% of people in care homes die within 12 months of admission. While nursing homes and care homes (hereafter residential homes) increasingly look after older people at end of life, there is no dominant model for providing specialist palliative support for those with most complex symptoms. This means that people are not able to live well until they die, and may experience unnecessary and distressing symptoms at end of life. This represents an inequality: older people in residential care should receive the same high quality of palliative care provided in the community.

This study is a feasibility/acceptability study to examine the implementation potential of a model of care used in Australia to sites in the UK. The Australian model has shown to have positive outcomes in a stepped wedge randomised control trial in 12 clusters. The model of care:

1. Reduces hospitalisations (saving more than $3.5million in a year)
2. Increases people dying in their preferred place
3. Increases staff confidence in looking after people at end of life
4. Improves quality of death, by reducing symptom burden and increasing anticipatory care planning

Design: mixed method implementation study, recruiting care homes across the UK to address the following objectives

(i) Acceptability (ii) Appropriateness (iii) Feasibility (iv) Implementation cost (v) Coverage (vi) Sustainability

Team is yet to be built, but approaches will be made early 2019 to Jo Hockley and Anne Finucane (care home + specialist palliative care expert, Uni Edinburgh), Jeremy Keen (highland hospice), Gemma Clarke (uni Leeds); Prof Brendan McCormack (expert in implementation science, QMU).