The period when someone is approaching the end of their life is inevitably difficult and emotional. People have the right to dignity and a ‘good death’.
All four of Brunelcare’s care homes have been rated ‘gold standard’ for their end of life care, having been accredited with the national Gold Standards Framework (GSF) Quality Hallmark Awards. These awards are presented to homes in the UK that demonstrate real improvement, even excellence, in the quality of end if life care they provide.
Gold Standard homes must achieve 20 quality standards, ranging from leadership and support to dignity and respect, as well as submitting a portfolio of evidence. Typically, GSF homes halve the number of their residents that die in hospital and halve crisis hospital admissions, leading to greater satisfaction for residents, their families and staff as well as significant cost savings for the NHS.
End of life care aims to support someone with advanced incurable disease to live as well as possible until they die. It also aims to support family and carers during this time and after the person dies.
In 2017 Brunelcare’s Glastonbury care home was given the highest ‘Platinum’ GSF award and it’s Deerhurst and Robinson House care and nursing homes, both based in Bristol, were given their first ‘Commend’ awards. In early 2018 Brunelcare’s Saffron Gardens care home also obtained the GSF Commend award.
To put this in context, the charity’s care homes were among 103 homes from the South West to achieve the success of winning a Quality Hallmark Award for the first, second or third time from the National Gold Standards Framework (GSF) Centre, the UK’s largest provider of training in end of life care. Of these, 48 homes have Platinum status and 15 have Commend status.
Explaining the difference this high quality end of life care makes, Sandra Payne, Brunelcare’s Head of Clinical Excellence, explains:
“Across all four of Brunelcare’s care homes, from October 2017 to October 2018 we have had 112 deaths in the homes and 10 in hospitals. This equates to just 8% of deaths occurring in hospital and demonstrates that the homes are excelling in providing end of life care and facilitating good deaths for the people living in our homes. Some hospital deaths are unavoidable where the person and their loved ones may wish for active treatment to the end of their days or where an acute and unpredictable medical emergency has taken place.”
Talking about Saffron Gardens recent GSF award, Buba Touray, Senior Nurse at Brunelcare’s Saffron Gardens care home says:
“We are very proud to have achieved our Gold Standard Frameworks commendation award. Everyone in the home, ranging from nurses to the activities coordinator and catering staff, is involved in regular reviews with the residents. All aspects of their lives are considered including spiritual beliefs, personal interests and care preferences. Our care teams talk to the residents about their end of life care, giving them the opportunity to make decisions and say what they want. This has helped the residents and their families feel secure that they will be comfortable and their preferences considered at all times.”
Summing up what the care from Buba’s End of Life care team meant to them, Julie Billitteri, daughter of Barbara Fudge, who received nursing and end of life care at Saffron Gardens, says (pictured above and below):
“I was able secure a room for my Mum in Brunelcare’s Saffron gardens care home after she was discharged from Bristol Royal Infirmary recovering from hip surgery after a fall, and sadly she also needed end of life care at this point. She spent the last week of her life in Saffron Gardens. The team at Saffron Gardens were immensely caring. They just couldn’t do enough for my Mum, me and my family. My Mum was cared for lovingly by the care team. My sister and I were allowed to stay overnight by Mum’s bedside and we were cared for just as well as Mum. All our family, including grandchildren, were welcomed to visit too. Everything that was happening to Mum was gently explained to us, we were never left in the dark. As a family we still feel so grateful for the outstanding care Mum received that week. To be with her right to the end like that is what we had always wanted for Mum. As a permanent mark of our thanks we felt moved to donate a thank you plaque for the care team to display in the nursing court where Mum stayed.”
Dr Andrew Taylor, Stockwood Medical Centre, Bristol, who works closely with Brunelcare also says:
“A few years ago we started performing regular planned visits to Robinson House Nursing Home as part of our service to patients there. It quickly became apparent to the manager of the home and I that there were lots of residents being admitted to hospital with little or no clinical benefit for them or their quality of life. We decided we needed to be much more proactive in planning end of life care so that patients could spend their last days in the comfort of familiar surroundings with carers who knew their needs well. Over time this process has evolved so that documentation has generally improved in the nursing records and in the GP records. From an early stage of the patients stay in a nursing home an open and frank discussion about end of life care is had when appropriate. From the GP point of view this has helped improve the care we offer patients and has made us think about end of life care issues for patients early on. This has made decision making easier during an unplanned crisis.”
For many people a ‘good death’ simply means being treated with compassion and respect; being kept clean, comfortable and free from distressing symptoms; and being in a familiar place surrounded by those close to them. From a medical point of view, it is about providing thoughtful and holistic care without causing unnecessary distress with unhelpful medical intervention.
Planning for the end of someone’s life is not easy. Many people sometimes fail to do so or are over pessimistic, thinking it may avoid unnecessary and disturbing investigations, treatments, journeys to and stays in hospital.
Discussing issues earlier rather than later makes decision making easier and less rushed. The key to good end of life care is open, responsive and effective communication with all involved taking into account the individual’s physical and mental fitness and any expressed wishes.
15 of Brunelcare’s employees completed a mental health first aider training course delivered by Care First.
Brunelcare is running dementia information sessions to provide information and support to relatives of people living with dementia.
Brunelcare has been running a campaign to promote hydration across the organisation as part of our employee assistance programme.