Search

Care homes care for people with complex needs, supporting them to the end of life and are now being seen as the ‘de facto’ hospice. Reflective debriefing for care home staff has been found to help support staff and provide an educative and communicative function when a resident dies. Pre-COVID-19, one of the authors had been conducting reflective debriefings face-to-face with care home staff but when COVID-19 struck, face-to-face sessions were impossible. An online format was developed with the aim of providing emotional support and practice-based learning in relation to death and dying through reflection. This study assessed the acceptability and feasibility of delivering online supportive conversations and reflective sessions (OSCaRS) on palliative and end of life care to care home staff during the pandemic. A mixed methods study design was undertaken in April to September 2020. Qualitative data comprised of digital recordings of sessions and semi-structured interviews with OSCaRS participants, managers and session facilitators. An online survey was sent to all staff and had a response rate of 12%. Eleven OSCaRS were conducted over ten weeks. Thirty-four staff members attended one or more sessions. Three overarching themes were identified from the data: pressures of working in a pandemic, practicalities of delivering online support and, practice development opportunities. Engaging care home staff in online structured supportive conversations and reflections in relation to death and dying is acceptable, feasible and valuable for providing support with the pressures of working in a pandemic. There is value for OSCaRS to continue as online sessions as they provide care home staff access to practice-based learning and support from professionals and allows specialists based in a range of settings to in-reach into care homes in an efficient way. Future implementation must consider the availability of sufficient devices with cameras to aid participation, timing and frequency of sessions to accommodate staff workflows, the engagement and support of managers and post-session support.

This project examined the impact of social distancing on care home communities as a result of lockdown to minimise threats of COVID-19 with a particular focus on the health and well-being of family carers and investigated measures taken by care home staff to help families to stay in touch with their relatives in care homes.

Additional file 1.

Additional file 2. [32–140]

A short, accessible summary of the project’s background, findings, conclusions and recommendations.Full report on assessing the impact of visiting restrictions on families of care home residents during COVID-19. Key findings and recommendations arising from the project’s research.

Importance: High-quality evidence on how to improve palliative care in nursing homes is lacking. / Objective: To investigate the effect of the Palliative Care for Older People (PACE) Steps to Success Program on resident and staff outcomes

Background The number of residents in long-term care facilities (LTCFs) in need of palliative care is growing in the Western world. Therefore, it is foreseen that significantly higher percentages of budgets will be spent on palliative care. However, cost-effectiveness analyses of palliative care interventions in these settings are lacking. Therefore, the objective of this paper was to assess the cost-effectiveness of the ‘PACE Steps to Success’ intervention. PACE (Palliative Care for Older People) is a 1-year palliative care programme aiming at integrating general palliative care into day-to-day routines in LTCFs, throughout seven EU countries. Methods A cluster RCT was conducted. LTCFs were randomly assigned to intervention or usual care. LTCFs reported deaths of residents, about whom questionnaires were filled in retrospectively about resource use and quality of the last month of life. A health care perspective was adopted. Direct medical costs, QALYs based on the EQ-5D-5L and costs per quality increase measured with the QOD-LTC were outcome measures. Results Although outcomes on the EQ-5D-5L remained the same, a significant increase on the QOD-LTC (3.19 points, p value 0.00) and significant cost-savings were achieved in the intervention group (€983.28, p value 0.020). The cost reduction mainly resulted from decreased hospitalization-related costs (€919.51, p value 0.018). Conclusions Costs decreased and QoL was retained due to the PACE Steps to Success intervention. Significant cost savings and improvement in quality of end of life (care) as measured with the QOD-LTC were achieved. A clinically relevant difference of almost 3 nights shorter hospitalizations in favour of the intervention group was found. This indicates that timely palliative care in the LTCF setting can prevent lengthy hospitalizations while retaining QoL. In line with earlier findings, we conclude that integrating general palliative care into daily routine in LTCFs can be cost-effective. Trial registration ISRCTN14741671.