Family Perception of Care

We are very grateful to the Burdett Trust for Nursing for having funded this audit for two years.

Family Perception of Care – measuring quality of care at end of life in nursing care homes: Jean levy, Fran Conway and Julie Kinley

There has been considerable interest in reducing ‘inappropriate hospital admissions’ from nursing care homes (NHs). Over the last several years the numbers of residents remaining in their nursing care home to die rather than being inappropriately admitted to hospital has risen from 57% in 2007/8 (324 deaths across 19 NHs) to 78% in 2014/15 (1159 deaths across 76 NHs). We believe this has largely been due to the intensive facilitation of the Gold Standards Framework in Care Homes (GSFCH) and the on-going relationship through the ‘sustainability initiative’ that the Care Home Project Team (from St Christopher’s Hospice) have secured with nursing home managers, their staff and GPs.

Increasing the number of residents dying in their NH is one thing, but monitoring the quality of care during the dying period is quite another. However, measuring and monitoring the quality of care is quite complex, as who is the best person to ask in order to get an honest picture once the resident has died; is it staff or can families be asked? In the past, there had been no regular monitoring of such care. However, in 2012/13 the Care Home Project Team set up a pilot audit in Croydon, using the Family Perception of Care scale to measure the quality of care given to residents who died in all the NHs in Croydon (2012/2013). Following the pilot, the Burdett Trust for Nursing kindly funded an audit of end of life care across care homes in all our catchment areas. Initially agreed for one year, the Burdett Trust then generously extended the funding for a further year. 

The aim of the audit was:

  • To enable the care homes to use the views of bereaved family members to learn about and develop the end of life care they provide
  • To send the FPoC questionnaire to next of kin of deceased residents three months after the death
  • To analyse the results
  • To feedback collated results to each nursing home via an established core team reflective de-briefing group
  • For the care homes to develop Action Plans for improvement based on the results

The audit encompassed 75 care homes in Bromley, Croydon, Lewisham, Lambeth and Southwark. Care homes sent out questionnaires to bereaved relatives three months after a death, for anonymous return to St Christopher’s for analysis. Six monthly feedback reports enabled the participating care homes to learn about issues highlighted as important or needing improvement by those relatives, and St Christopher’s Care Home Project Team worked with the care home staff to produce action plans aimed at improving and developing their end of life care.   The results for year two showed 80% of respondents agreed or strongly agreed that they were overall satisfied with the end of life care provided by the care homes, and 84% agreed or strongly agreed that the resident was treated with dignity.  Areas with lower agreement (less than 50%) included the GP having time to discuss issues and availability of Chaplaincy services.

Posters & Presentations

Levy J, Conway F, Kinley J. Reaching out to work with others: how hospice is using bereaved carers views to improve end of life care in the UK. Poster, EAPC Copenhagen, May 2015 – Download poster (PDF) 

Levy J, Conway F, Kinley J.  The delicate art of communication about end of life care in South London care homes.  Poster, Hospice UK Conference, September 2015 – Download poster (PDF)

Levy J., Kinley J. and Conway F. (2016) The challenges of implementing a multi-centre audit in care homes International Journal of Palliative Nursing 22(11), 534- 540.