Neighbourhood working to improve care outside hospital setting
Work is underway to ensure care home residents across Lincolnshire have an Advance Care Plan in place – with the aim of better understanding their wishes as patients.
Advance Care Plans are documents where people can ensure their wants and wishes for future care are readily available for all health and social care professionals.
They contain all decisions and wishes in terms of their preference for level of care and interventions they receive as they approach end of life, and outline where they wish to receive this care.
In the south of Lincoln, the HomeHealth team have been working with care homes to work towards putting together Advance Care Plans for the most severely frail residents.
In future, all residents will have one in place.
Angela Shimada, Neighbourhood Lead for Lincoln South, said: “First and foremost, the completion of Advance Care Plans opens up frank and honest discussions with residents and their families.
“It provides a supportive process for them to explore their thoughts and concerns, and often helps families to come to terms with the deterioration of their relative. It provides comfort in difficult times, as it means that the resident is not subjected to any unnecessary interventions and it also means that families are not being asked to make decisions during a crisis as the plan is already in place.
“A lot of residents preferred place of care and death are in their care homes. They would much prefer to be kept comfortable in a familiar environment, with staff that know them well.
“Unnecessary admission to hospital causes a lot of stress and concern for residents and their families.
“HomeHealth have been building relationships with care homes to ensure that they feel confident to utilise the advance care plans and ensuring that they have the support in place to be able to enable them to help residents achieve their preferred places of care and death.
“We have been trying to promote Advance Care Planning and trying to encourage people to consider it at the earliest opportunity in order to avoid crisis point.”
Advance Care Plans are just one of a number of initiatives taking place within communities across Lincolnshire to improve care provision outside of the hospital setting.
The Home First Prioritisation programme has been working with East Midlands Ambulance Service and other organisations to try and identify reasons for unnecessary hospital conveyances, before working with Neighbourhood Leads to implement measures to remove these blockages.