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Everyone should have the right to high quality person-centred care at the end of life, regardless of their circumstances or where they live. Despite this, care home residents often don’t get access to specialist palliative care. Improving access is pertinent given that care homes increasingly provide care for people at the end of life, with up to 56% of residents dying within the first year of admission. With an ageing demographic, this is set to increase, and care homes are estimated to be the most common place of death by 2040.
It is therefore crucial that specialist palliative care is extended to address inequity in access across different care settings and geographies. Despite a need for further investment in services, the social care sector is in crisis. Social care has long been a Cinderella service in comparison to the NHS, with a lack of universal service provision and gross underfunding.
There are significant disparities between those who are self-funding and those using public funding to pay for their care home place, with privately funded residents paying significantly higher amounts. We conducted interviews as part of the Needs Round project and some care homes told us that local authority funding rates were not enough to cover the cost of providing high quality care. Care home workers are underpaid and undervalued, and often lack access to appropriate training, key issues that contribute to the transient nature of the care home workforce. This impacts care quality: to build good quality trusting relationships takes time.
Covid has exposed the entrenched inequalities between health and social care, through for example, residents being transferred from hospitals to care homes without being tested for covid, a lack of access to PPE, and a reduction in face to face support from primary care. This underlines the urgent need to improve the lives and deaths of care home residents.
“People should have access to high quality palliative and end of life care, regardless of where they live. Needs Rounds aim to address this inequality by improving access to specialist palliative care for care home residents. We are working with homes in a range of settings, including rural communities and areas with high socio-economic deprivation”.
Through monthly triage meetings, residents at risk of dying without a plan in place or with uncontrolled symptoms, are discussed to understand their physical, psycho-social, and spiritual needs, enabling tailored action plans to be created to address these. Needs Rounds include education for staff, multi-disciplinary team meetings to draw in a range of expertise, and clinical support from specialist palliative care clinicians. This helps to build staff skills and confidence, improves advance care planning so that residents’ wishes are understood, documented, and acted upon, and reduces avoidable hospitalisations.
Embedding equality and diversity is central to everything that we do, including our recruitment practices. We are currently looking to hire a Research Fellow who is committed to improving the lives and deaths of older adults. If you share the same values of equality and justice, then take a look at our advert here. We strongly encourage people from a range of diverse backgrounds to apply and welcome those looking for a job share opportunity or part time position. You can apply here, or if you’d like to hear more about what the role involves then please contact Liz Forbat at elizabeth.forbat1@stir.ac.uk.
Needs Rounds are intended to provide more equal access to specialist support at the end of life. Is that what you want too?