To implement ‘Living & Dying Well’ across all settings in Aberdeenshire. A dedicated Project Manager was appointed to facilitate implementation of Living & Dying Well in Aberdeenshire. Previous work had focused on Aberdeenshire Care Homes which had been very successful in raising awareness of the identification, assessment and ongoing review of palliative patients using a facilitative, rather than an instructional approach. This had demonstrated that cross boundary working is possible and positive. There was a need to extend this approach to other primary care, social care, voluntary and independent care settings in order to provide all staff with the confidence they need to carry out effective, person centered palliative care for older people.
The aim of the Care @ Home project is to provide emotional and psychosocial support to people over 65 affected by Cancer, Motor Neurone Disease, Multiple Sclerosis and Parkinson’s Disease, allowing clients to remain cared for at home. The Project also provides support to the carer/family member affected by the illnesses.
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.
The number of people in the UK aged over 65 is growing and is forecast to reach 16.1 million by 2035. The burden of disease associated with aging will increase as will the demands on health services including end-of-life and palliative care. The National Confidential Enquiry into Patient Outcome and Death in 2008 found that rather than advanced care planning and palliation taking place, some patients were subjected to excessively active interventions in their last months of life.
The pilot study aimed to ascertain whether using primary and secondary care data to identify patients at risk of hospital admission and agreeing and implementing an Anticipatory Care Plan in this population could help to reduce hospital admission rates. Anticipatory care planning allows patients to express their wishes for care prior to a sudden deterioration in their health.