The importance of end of life care in care homes has been amplified in recent months to unprecedented levels. Even pre-Covid, experts were predicting a significant increase in the number of people expected to die in care homes.
Add in the higher status afforded to end of life care by CQC and there’s never been such an imperative for a care home to take stock, review where it’s at on this critical topic and consider participating in a programme to help it meet all of these priorities and ensure it’s best placed to provide all residents with quality care at the end of life.
Care home managers completing such a review will most likely conclude that, thanks to their commitment and that of their team, they are delivering generally good end of life care. What they might also determine is that establishing and embedding a system would help to guarantee that level of care for all residents all of the time.
Steps to Success programme
That’s where the Steps to Success programme comes in, providing homes with a resource to help them identify the processes involved in the provision of that quality end of life care. Meanwhile the St Christopher’s team provide ongoing support to ensure those processes match the needs of the home and are genuinely bedded in for all members of staff, clinical and non-clinical.
Maaike Vandeweghe, Senior Educationalist, says: “Steps to Success is the most flexible programme of its kind, designed absolutely to meet the requirements of the individual home. It is also incredibly practical and works to complement the homes existing end of life care skills.”
The first step for any home considering the programme is for the St Christopher’s team to complete an assessment to establish its strengths and weaknesses. The team will then devise a structure and programme tailored precisely to match the home and its unique needs.
One home was attracted to the programme precisely because of its lack of experience dealing with death and dying.
Steps really opened my eyes it helped give me the knowledge to understand when people are coming to the end of life, what is important at the end of life and how to prepare and care for them
Kate Winiarz, Manager of Norcrest, an 11-bed home for people with learning disability, said: “I was thinking about my clients aged over 60 and worried about their future in the home. I wanted to know how to support people as they approach the end of life. It’s particularly important for our clients as at least 80% of them are not suitable for hospitalisation and the change in environment could kill them.
“Steps really opened my eyes it helped give me the knowledge to understand when people are coming to the end of life, what is important at the end of life and how to prepare and care for them.”
Virtual learning sessions
The programme itself, which will now be delivered online, comprises six virtual learning sessions, each on focusing on one of the ‘steps’:
- Step 1 – Assessment, care planning, review
- Step 2 – Discussions as the end of life approaches
- Step 3 – Care in the last weeks/days of life
- Step 4 – Care after death
- Step 5 – Delivery of high-quality care
- Step 6 – Good co-ordination of care
Recognising the demands on care home staff time, the programme is designed to be manageable and the sessions are held every six to eight weeks and are all recorded and available to watch again.
That’s not to say Steps doesn’t require serious dedication from each home manager as Maaike Vandeweighe says: “It comes with a level of commitment for the manager to be an end of life care beacon, but that is balanced by the opportunities it provides for people to learn real practical skills and to think constructively about what could be done better. That commitment is also matched by the level of support we provide, and the programme delivers in terms of establishing resilience.”
Support for participating homes
Participating homes receive support on the programme from two sources. Firstly, they’ll attend the online sessions with other local homes who are at a similar stage, so they can help each other. Then, after a home has completed the sessions, members of the St Christopher’s team will visit to assist the home as it builds its portfolio to evidence the completion of the Six Steps. In addition, the team will make a minimum of three visits to the home when, for example, they might demonstrate how to conduct Advance Care Planning discussions.
Kate Winiarz says it’s this ongoing, close connection with the St Christopher’s team that she and her colleagues have really appreciated. She adds: “Being under the support of St Christopher’s has been amazing. They come and visit us, we can share our issues and they provide expert advice. That is so precious. The hospice nurses have helped us so much with their expert knowledge and practical experience.”
Thanks to Steps we now feel confident to manage the end of life of all of our residents and we have a closer working relationship with our GPs
Norcrest completed Steps to Success and received its accreditation certificate in 2019, after submitting its portfolio of evidence and undergoing onsite assessment. Despite the average age of its 11 residents being only 45, Kate has implemented a number of systems changes in order to ensure she and her team are fully prepared. These include quarterly meetings to assess the condition of all residents.
“Thanks to Steps we now feel confident to manage the end of life of all of our residents and we have a closer working relationship with our GPs. There are so many things you can take from the course and I think it is a big tool that provides huge help to provide great care.”
If you’d like your home, or know a home, that would like to have completed the Steps to Success a year from now, contact firstname.lastname@example.org for more information.