Background: Many care home residents have dementia and will be in the last months of life. People with dementia have poorer outcomes associated with hospital admission than people without dementia.
Innovation: A service aiming to improve quality of end of life care for residents with dementia was introduced to 7 care homes with a total of 283 residents. Assessments were undertaken with reference to Gold Standard Framework prognostic indicators. A total of 250 staff received education about delirium. Advance care planning was carried out with 102 patients and/or families, with plans sent to care homes, carers, general practitioners and secondary care.
Evaluation: Staff completed electronic questionnaires addressing confidence and knowledge about delirium before and after training. Carers' opinions were sought on how care planning was conducted. The Trust information department provided data for admissions. Data on deaths and place of death was collected from the care homes.
Improvements in staff confidence were seen in recognition (59%), prevention (57%) and management (50%) of delirium, and in knowledge of factors associated with delirium. Of the carers' questionnaires, 64 of 80 sent out were returned (80%). More than 92% carers rated the service ≥ 9/10. Admissions from the seven care homes fell from a baseline of 202 per annum to 136 in the first year, and 91 in the second year of the service. All but one resident with a care plan in place died in their or their family's preferred place of care during the service period. Of the residents with care plans who died, the care home was the preferred place of care for 55 and hospital the preferred place of care for 4. The resident who did not die in the preferred place of care had been admitted to hospital for an appropriate reason.
Conclusion: This service has improved care home staff knowledge about delirium, has helped care home residents with dementia have an alternative to hospital admission and greatly increases the chances residents dying in the preferred place of care. The positive feedback suggests this service model delivers effective communication about end of life issues in residents with dementia, which is highly valued by carers.