Hospice At Home (H@H)

A Journey with Hospice Mid-NorthlandDeb Yarrall and Jenny Coleman

Overview

Hospice Mid-Northland

History of respite beds

New initiative

Evaluation of initiative

Where to from here?

Our Bus “ Coffin Dodger ”

Paris?

Paris

Everest?

Mt Everest

London?

Click icon to add picture

London

Rome?

Rome

The Caribbean?

The Caribbean

10

Northland

Cape Brett Lighthouse, Bay of Islands and The Treaty Grounds, Waitangi

He aha te mea nui o te ao? What is the most important thing in the world ?

He tangata He tangata He tangata It is people, it is people , it is people

12

Far North Community Hospice

Hospice Mid-Northland

Hospice Kaipara

North HavenHospice

Hospice Mid-Northland

Respite unit with two beds

Survey of the community 2011

In-depth review of the unit 2012

14

The Outcome

Florence Nightingale at the end of her life - at home

A Fork in the Road

Preferred Place of Care

WHAT WE HEAR:

Most people want to die at home

A patient's home in the bay

Preferred Place of Care

WHAT IS ACTUALLY TRUE:

Most people in NZ (22%) do not die at home (PCC, 2011)

however

2003-2007 65% of HMN patients died at home

2007-2014 69% of HMN patients died at home

(Palcare stats)

Therefore

Hospice@Home

Respite care in the home

72 hours

Registered nurse or caregiver

To reduce risk of carer burden and to assist with medication management

Based on a full assessment

(HMN H@H Policy, 2012) The rural roads of Mid-Northland

What Else Does the Literature Say?Themes:

Less dying in hospitals/ in-patient facilities and more in community settings/in homes

Timely support

A high level of care

Economically sustainable

Reduce caregiver burdenPurerua Peninsula

Carer Burden

‘relatives of patients cared for in a late palliative phase suffer from great fatigue and require more attention, both scientifically and in the clinical setting’

(Carlsson, 2010, p.1

Local innovation for a high needs patient at home

What is happening in NZ?

HNZ Quality Group

Lake Taupo Hospice Northhaven Hospice Waipuna Hospice Hospice North Shore Hospice Tairawhiti

Time to Stop and Look at the View

Tauranga Bay, Northland

How Are We Doing?

Hours

Staff – RN or CG

Mileage

Timing

Ease of organising

Support of families and H@H staff

(HMN H@H Policy 2012).

Te Tii Bay, Paihia

Outcomes – Audit 1 (Jan-July

2013)

10 families/230 hours

All nights except one episode

72 hours never used

Half RN and half CG

Outcomes – Audit 1Timing was appropriate

Mileage varied but is significant

Not easy to arrange

Families and H@H staff felt supported

Outcomes – Audit 2 (Aug 2013 to

July 2014)

15 Families/498 hours (135 ACC funded)

26% Maori families

72 hours used only once (and ACC funded)

All nights except on two occasions

370 RN hours and 128 CG hours

Te Haumi Flat, Paihia

Outcomes – Audit 2Timing appropriate

Mileage remains significant

Easier to arrange

Families and H@H staff felt supported

Our Coffin Dodger with his fish!

We get all kinds of families

“It wasn’t expected but gratefully received and the nurse was lovely, but I would’ve liked an IPU in the Mid-North.”

“Gave carer a break, willing to stay, being Maori was excellent”

“Being able to sleep”

“The reassurance and peace of mind.”

Palliative Care Team Comments

The HMN Palliative Care Team, 2014

H@H Staff Comments

Not even a road this time!

Conclusions

PROS

Relieved carer burden

Timely manner

Enabled patients and families to remain at home

BUT

It’s not always easy to arrange

? Economically sustainable

People still need choice about their PPC

The way ahead is hazardous

And conditions challenging

The Winterless North!

We hope we are not on borrowed time…..

The front of the Coffin Dodger's vehicle

Where to from here?Funding

Partnerships – eg◦ Local Hospitals◦ ARC◦ Maori Health

Providers◦ Home Support

Agencies◦ Private Agencies

Some signposts are from last century

Proceed with caution

Case by case basis

Limited budget

Onward…..

Kua tawhiti ke to haeranga mai, kia kore e haere tonu

He tino nui rawa ou mahi, kia kore e mahi nui tonu.

You have come too far, not to go further

You have done too much not to do more.

Ta Himi Henare

Ngati Hine 1989

Appendix 1 (Audit Tool Jan-July 2013)

Appendix 2 (Audit Tool Aug 2013 to July 2014)

   Patient

 Demographic

 Hours

 RN/CG

 Mileage km

 Timing appropriate? 

 PolicyFollowed?

 Did the team find it seamless to arrange?

 Did the H@H nurses feel supported?

 Did the family gain relief and support

 Pt 1

 NZE

 2x 12

 CG

 N/A

 Yes

 Yes

 Yes

 Yes

 Yes

 Pt 2

 Maori

 1x 12

 RN

 76

 Yes

 Yes

 Yes

 N/A

 N/A

 Pt 3 *

 NZE

 9x 12

 RN

 192

 Yes

 Yes

 Yes

 Yes

 Yes

 Pt 4

 NZE

 1x 10

 RN

 85

 Yes

 No

 No

 Yes

 Yes

 Pt 5 *

 NZE

1x82x92x10

 RN

 60

 Yes

 Yes

 No

 Yes

 Yes

 Pt 6

 NZE

 4x 12

RNx36CG x12

 256

 Yes

 Yes

 No

 Yes

 Yes

 Pt 7

 NZE

2x 4 day2x 12 day1x 12 night

CG x20RN x24

   Yes

 Yes

 Yes

 Yes

 Yes

 Pt 8

 Maori

1x121x 71x 10

 RN

 N/A

 Yes

 Yes

 Yes

 Yes

 Yes

 Pt 9

 NZE

 2x 121x3

 RN

 N/A

 Yes

 Yes

 Yes

 Yes

 N/A

 Pt 10

 NZE

 4x12

 CG

 288

 Yes

 Yes

 Yes

 Yes

 Yes

 Pt 11

 NZE

 4x12

 RN

  

 Yes

 Yes

 No

 Yes

 Yes

 Pt 12

 Maori

 1x12

 CG

 170

 Yes

 Yes

 No

 N/A

 Yes

 Pt 13

 NZE

1x 121x 14.51x 3.5

 RN

 N/A

 Yes

 Yes

 Yes

 Yes

 Yes

 Pt 14

 Maori

 1x 4 –eve3x 2 - eve

 CG

 24

 Yes

 No

 No

 Yes

 Yes

 Pt 15

 NZE

 1x 2 -day

 CG

 22

 Yes

 No

 Yes

 Yes

 Yes

 Totals

 11x NZE4x Maori

 498

 128 CGh370 RNh

   100%

 80%

 60%

   

ReferencesButler, C., and Holdsworth, L. (2013). Setting up a new evidence-based hospice-at-home service in England. International Journal of Palliative Nursing. (19) 7. 355-359. Retrieved from Proquest Central Database.

Carlsson, M.E. (2010). The significance of fatigue in relatives of palliative patients. Palliative and Supportive Care. (8). 137-141. Retrieved from Proquest Central Database.

DeMiglio, L., and Williams, A.M. (2013). A qualitative study examining the sustainability of shared care in the delivery of palliative care services in the community. BMC Palliative Care. (12). 32. http://www.biomedicalcentral.com/1472-684X/12/32 Retrieved 20 August 2014

Howell D, et al. (2011). A shared care model pilot for palliative home care in a rural area: impact on symptoms, distress and place of death. Journal of Pain and Symptom Management. (42) 1. 60-74. Retrieved from Science Direct.

Hospice Mid-Northland. (April, 2012). Hospice Mid-Northland Inpatient Review. Hospice Mid-Northland.

Hospice Mid-Northland. (November, 2012). Hospice Mid-Northland Hospice@Home Policy. Hospice Mid-Northland.

References

Hunt, K.J., Shlomo, N., and Addington-Hall, J. (2014). End-of-life care and achieving preferences for place of death in England: results of a population-based survey using the VOICES-SF questionnaire. Palliative Medicine (28). 412-421. Retrieved from Sagepub August 21 2014.

McNamara, B., and Rosenwax, L. Factors affecting place of death in Western Australia. (2007). Health and Place. (13). 356-367. Retrieved from Elsevier.

Ministry of Justice. (1993). The Privacy Act. Wellington, New Zealand. Retrieved from www.legislation.govt.nz/act/public/1993/0028/latest/DLM297038.html

Munday, D., Dale J., and Murray S. Choice and place of death: individual preferences, uncertainty, and the availablity of care. (2007). Journal of the Royal Society of Medicine. (100). 211-215. Retrieved from NCBI Database.

Nursing Council of New Zealand. (2012). Code of conduct for nurses. Wellington: Nursing Council of New Zealand.

ReferencesSheppard, S., Wee, B., & Straus, S.E. (2012). Hospital at home: home-based end of life care (Review). Retrieved October 3, 2013, from The Cochrane Library: The Cochrane Collaboration. Published by John Wiley & Sons Ltd.

Te TaiTokerau PHO. (2008-2013). Te Tai Tokerau Maori Health Strategic Plan. Te Tai Tokerau PHO.

The Palliative Care Council of New Zealand. (2011, June). National Health Needs Assessment for Palliative Care. Phase One Report: Assessment of Palliative Care Need. Retrieved August 20, 2013, from Cancer Control New Zealand: http://www.cancercontrolnz/govt.nz/sites/default/files/Needs%20Assesst%20Report.pdf

Williams, A-L., and McCorkle, R. (2011). Cancer family caregivers during the palliative Hospice, and bereavement phases: A review of the descriptive psychosocial literature. Palliative and Supportive Care. (9) 315-325. Retrieved from Proquest Central Database.

References Wye, L., Lasseter, G., Percival, J., Duncan, L., Simmonds, B., and

Purdy, S. (2014). What works in ‘real life’ to facilitate home deaths and fewer hospital admissions for those at end of life?: results from a realist evaluation of new palliative care services in two English counties. BMC Palliative Care. (13). 37. http://www.biomedcentral.com/1472-684X/13/37. Retrieved 20 August 2014.