Streamlining the processes involved in hospital discharge for people with both health and social care needs was fragmented and dealt with as separate aspects of discharge by different professionals at both the hospital and the council. The processes involved delays for the person in hospital while supports were put in place.
Palliative care is not just “terminal care” over a few weeks or days. Palliative care approaches are relevant to people living with advance disease, regardless of length or clarity of prognosis.
Around 38 000 people with palliative care needs die in Scotland each year and a much larger number are living with advanced progressive disease. Most are older people. Around 30% of acute bed days are used by people in their last year of life, and over 50% of people will die in hospital, although most people express a preference to die at home. How Scotland cares for those approaching the end of life is therefore an issue of major and universal significance for the Scottish population and has a major impact on how Scotland uses scarce healthcare resources.
Palliative care is an integral part of achieving the transformational change (and shift of resources) envisioned in Reshaping Care for Older People. Regardless of the success of preventative strategies death and dying is inevitable. And unless we get this part of the trajectory right we are likely to continue to commit huge health care resources to providing care in the acute sector for people whose preference would be for care elsewhere.
Good quality palliative and end of life care is fundamental to delivering the safe, effective and person-centred care described in the Dementia Strategy and the Healthcare Quality Strategy.
Research indicates that patients who have been identified and placed on a palliative care register are more likely to have their needs/wishes met, for example they are more likely to die at home (75%) as opposed to those who are not on the register (22% die at home). Currently, most people on a register have a cancer diagnosis but palliative care is relevant to people with any advanced life threatening disease. References: Murray S.A, Boyd K, Sheikh A, Thomas K, Higginson, IJ. Developing primary palliative care. BMJ. 2004; 329:1056.
One example was a lady with Dementia who was referred in order to consolidate support available and identify any areas that might require assistance. However, during preparation it transpired that this elderly lady was also a victim of financial abuse. The family knew this was going on and wanted it stopped but did not know what to do about it. The Family Group Meeting brought these concerns into the open. Social work was informed of these allegations but they agreed to wait for the outcome of the Family Group Meeting before pursuing their own enquiries.