National Homecare Conference Anne Willis Hospice Manager : Marie Curie Hospice : Edinburgh.

National Homecare Conference Anne Willis Hospice Manager :Marie Curie Hospice : Edinburgh.

The Role of Hospice Care. The Role of Hospice Care.

What do Hospices What do Hospices do? do?

Current challenges Current challenges for Hospices .for Hospices .

The role of The role of Hospices in end of Hospices in end of life care at Home. life care at Home.

Hospices World Wide. Hospices World Wide.

Now 7,000 Hospices in over 90 countries.In Europe largest number are in Poland 246 , France, Germany and Sweden.In Scotland 19 Adult Hospices , 2 Childrens Hospices .13 are independent voluntary organisations supported by their local communities.Health Boards provide £13 million. 40% of Hospice Running Costs. All Hospice care is Free.

The Hospice Movement. The Hospice Movement.

Started with Dame Started with Dame Cicely Saunders Cicely Saunders who founded the who founded the first Hospice in the first Hospice in the UK. UK.

Dedicated to Dedicated to patients with cancer patients with cancer and the concept of and the concept of ‘What is in your mind and in ‘What is in your mind and in your heart’ ,your heart’ ,

What is the aim of a Hospice ?What is the aim of a Hospice ?

Optimise quality of life before a timely , Optimise quality of life before a timely , dignified and peaceful death .dignified and peaceful death .

A place for comfort, care and support. A place for comfort, care and support. Lead and Influence the development of Lead and Influence the development of

palliative care services locally and palliative care services locally and nationally. Scottish Government Action nationally. Scottish Government Action Plan : Living and Dying Well .Plan : Living and Dying Well .

A local resource , supported by the A local resource , supported by the community .community .

REFERRAL REFERRAL Patients with advanced, progressive or incurable Patients with advanced, progressive or incurable

disease who need palliative care. disease who need palliative care. Patients in any setting, home , hospital or care home.Patients in any setting, home , hospital or care home. Telephone advice, a single assessment or a period of Telephone advice, a single assessment or a period of

specialist care .specialist care . Referral for any patient who has complex end of life Referral for any patient who has complex end of life

symptoms, uncontrolled pain or other symptoms, symptoms, uncontrolled pain or other symptoms, complex, physical, psychological , spiritual or family complex, physical, psychological , spiritual or family needs that cannot be met by the existing team. needs that cannot be met by the existing team.

Palliative Care GuidelinesPalliative Care Guidelines Any health professional in discussion with GP Any health professional in discussion with GP

The Challenges. The Challenges.

Services in last Services in last weeks or months of weeks or months of life.life.

Associated with Associated with dying limits dying limits acceptability .acceptability .

Resource Resource constraints . constraints .

8,000 each year8,000 each year ¼ cancer¼ cancer 1/3 dementia/frailty1/3 dementia/frailty 1/3 organ failure1/3 organ failure 1/12 sudden1/12 sudden >50% in hospital>50% in hospital

Activity Tells a Story .Activity Tells a Story .

07-0807-08 08-0908-09

AdmissionsAdmissions 394394 456456

DischargesDischarges 215215 228228

DeathsDeaths 326326 362362

CNS Visits at CNS Visits at Home.Home.

23722372 25612561

Cancer Care : Inpatient Care Cancer Care : Inpatient Care

““After eight days, I After eight days, I was able to return was able to return home,and my wife and home,and my wife and I went on holiday up to I went on holiday up to the north of Scotland. the north of Scotland. Sitting next to Sitting next to beautiful Loch Linnhe, beautiful Loch Linnhe, we felt so relaxed, and we felt so relaxed, and had a lovely week.”had a lovely week.”

Social and Psychological Support: Social and Psychological Support: Day and Outpatient Services. Day and Outpatient Services.

‘ ‘ I take one step I take one step forward and then forward and then two steps back ‘two steps back ‘

I’d like to get I’d like to get better , but I keep better , but I keep getting a bit getting a bit worse. worse.

ComradeshipComradeship

We are all in this We are all in this together , so lets together , so lets talk about it. talk about it.

Psychological and Psychological and spiritual support.spiritual support.

Skype/ Blogging Skype/ Blogging your cancer friends your cancer friends .Linking to Maggies .Linking to Maggies Centre. Centre.

Comfort for Carers .Comfort for Carers .

Complementary Complementary therapies for carers therapies for carers and patients .and patients .

Support for Carers Support for Carers at Home ,- respite at Home ,- respite and befriending .and befriending .

Palliative care Palliative care workshops with workshops with VOCAL VOCAL

Hospice in the Community Hospice in the Community

Raising awareness Raising awareness about death , dying about death , dying and grief. and grief.

Bereavement care. Bereavement care. Involving and Involving and

engaging with local engaging with local organisations. organisations.

Frailty and Dementia Frailty and Dementia

Focus on Care Homes Focus on Care Homes ..

Advanced care Advanced care

plans even earlier .plans even earlier . Pain Assessments Pain Assessments Education.Education. EOL EOL

conversations .conversations .

The Role of Hospices : End of Life The Role of Hospices : End of Life Care at HomeCare at Home

Working with GP ‘s to Working with GP ‘s to review Palliative Care review Palliative Care Registers.Registers.

Advice and Review of Advice and Review of Specific patients at Specific patients at home or in home or in Outpatients .Outpatients .

Carers Support.Carers Support.

Clinical systems Clinical systems development .LCP , development .LCP , DNAR , Pain DNAR , Pain Assessment , OOH Assessment , OOH Communication.Communication.

Allocated Care Homes Allocated Care Homes , end of life care , end of life care planning , education planning , education and modelling of best and modelling of best practice. practice.

Aiming to Equip Other Aiming to Equip Other ProfessionalsProfessionals

Better assessment and management of Better assessment and management of pain .pain .

Importance of advanced care planning Importance of advanced care planning versus ‘ striving to keep alive’versus ‘ striving to keep alive’

Recognising dying ,- taking responsibility Recognising dying ,- taking responsibility and promoting importance of end of life and promoting importance of end of life decision making . decision making .

Promoting an outlook on death and Promoting an outlook on death and expectations which relate to reality to expectations which relate to reality to prevent unnecessary admissions or prevent unnecessary admissions or aggressive treatments. aggressive treatments.

‘‘We face a big challenge in endWe face a big challenge in end--ofof--life care , not because of life care , not because of demographics, but due to demographics, but due to

ignorance and prejudice among ignorance and prejudice among practitioners and the general practitioners and the general

public, failing to apply evidence public, failing to apply evidence to develop best practice and to develop best practice and

failing to spread good practice.failing to spread good practice.’’((PhilpPhilp, 2003: 153), 2003: 153)

References.References. Philp I ( 2003) End of Life Care for Older People. European Philp I ( 2003) End of Life Care for Older People. European

Journal of Palliative care ,10 (4) : 151-153.Journal of Palliative care ,10 (4) : 151-153.

www.mariecurie.org.uk/dementiawww.mariecurie.org.uk/dementiaproject2009.project2009. http://www.scotland.gov.uklivinghttp://www.scotland.gov.ukliving and dyingwell and dyingwell