Frequently asked questions

Palliative Care Home Support Service

1. What happens when the service receives a referral?

The information on the form is used to assess and plan care.  Our service works towards providing care for all patients who meet the criteria of the service ie: less than four to six weeks life expectancy and who wish to be cared for at home.  If possible, someone from the team will meet the patient and the family to plan and discuss arrangements but in urgent circumstances, especially if the patient is already at home, then care may begin immediately.

2. How quickly is care provided?

Of the 308 patients who received a care package from our service 78% were at home when referred and 22% were either in hospital or hospice.
(information from 07/08 PCHS Annual Report)

a. For those who were at home when referred:

•  49% received care on the same day (compared with 47% last year)

• 88% received care within one day

• 97% received care within two days of referral

b. For those who were in hospital or hospice when referred:

• 40% received a care package at home within 2 days

• 63% received a care package at home within 3 days

The reasons that care is not in place as quickly for the second group include preparation for care at home and uncertainty about whether it is possible for the patient to go home.  Preparation includes ordering and delivering of equipment, adjustment of symptom control and arranging some elements of care.  Currently the service is dependent on nursing and domiciliary care agencies for evening visits.  Uncertainty about whether it is possible for someone to go home is linked with the amount of care available as well as the condition of the patient, particularly regarding their ability to travel home.  The service tries to arrange care as quickly as possible for all patients but, for this group, it is particularly helpful to have reasonable notice so that care can be in place as soon as possible.

3. Do all patients referred to the Home Support service receive a package of care at home?

In some cases it is not clear whether the person referred will be able to return to, or continue staying at, home.  Reasons for this vary but may include family circumstances, eg living alone or with an elderly family member as the main carer. 

For people who really want or need the support of someone with them continually throughout the 24 hour period the service is not usually able to provide care and this is explained at an early stage so that other options (such as nursing home or hospice admission, if appropriate) may be considered.

4. What illnesses did patients referred to the service have?

Patients with any diagnosis may be referred to the service. This year 91% of patients receiving a care package had cancer. 

In cases where it has been difficult to estimate prognosis the service has responded by offering an initial episode of care with a plan to review at an earlier stage than usual. 

If the team is unfamiliar with a particular illness, advice is sought from the referring team or other relevant source.

5. How does the service work with other teams and services?

Our team endeavours to work in a collaborative way with others.  For example, the district nursing team retain their usual role to ensure continuity of existing relationships and overall care management, even if a great deal of care is provided for the patient by this service.

Our service shares information with all relevant teams to ensure the best overall care for the patient.  An example of this would be liaising closely with the relevant hospice team to ensure the best possible symptom control and continuity of emotional support from the relevant clinical nurse specialist.  The service communicates regularly with all who are involved to ensure that care is adjusted in response to the changing needs of the patient.

6. How are family members included?

Care is planned to meet the needs of the patient and their family members/carers as far as possible.  Sometimes it is important for family members to continue to be involved in the practical care of the patient themselves.  This is often achieved but is always negotiated carefully to achieve the right balance for all concerned.

Following the death of the patient a condolence card is sent by the team and a visit to say goodbye is offered to those who would like that opportunity. 

7. How does the service provide care equitably and how is it monitored and evaluated?

The Home Support service has aimed to provide care that is available to all despite their individual circumstances.  In addition to the routine demographic and clinical information needed to provide care, consideration has been given to particular factors that might indicate social disadvantage. These include:

• family reasons (to include ill health or other problems faced by family members)
• impoverished home environment
• rural location (which might contribute to social isolation or increased difficulty in accessing some components of care) and
• whether the patient lives alone or usually lives alone but is temporarily housed with someone else.