Care in Place- End of Life Program in a Long Term Care Setting

Abstract Description

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Authors (including presenting author) :

Hui E (1), NG WWL (1), YUK KL (1) MAK K YM(2),YEUNG W (2) LEUNG CTY(3) CHONG JSP (4) WAN JKM (5)

Affiliation :

(1)Department of Medicine and Geriatric SH (2)Nursing Department, Cheshire Home, Shatin (3)Physiotherapy Department, Cheshire Home, Shatin (4)Occupational Department, Cheshire Home, Shatin (5)Medical Social Service Unit , Cheshire Home, Shatin

Introduction :

Cheshire Home, Shatin (SCH), 304 beds, 70% of residents is frail elderly with multiple irreversible comorbidity, poor cognitive function and high dependency. Deteriorate residents will be transferred to acute hospital receiving invasive treatments. It may lead to inappropriate use of hospital resources and prolong residents’ suffering. Residents may die in an environment with strict visiting hours and poor bereavement. In view of this, a new service model emphasized end of life care was introduced in the long term care setting of SCH in July 2018.

Objectives :

The program was aimed at providing choice for the residents for the treatment options and place of care. Reducing unnecessary transferred to acute hospital while they were cared in place where they were familiar with and received non-invasive comfort care treatments. Quality of life and dignity of patients were preserved until the end of their life.

Methodology :

A new model included increase number of doctor’s round, senior round, and multidisciplinary case conference. Clinical handover was enhanced through systematic documentation in clinical management system and information technologies advancement. Clinical support was improved via call system reformed and use of information technology. Promotion of end of life was carried out in the long term care setting. Advance care planning (ACP) was introduced to offer choice for residents on their treatment options and the place of care. Treatment care plans were developed early before resident’s condition became deteriorates. Elderly friendly, person-centered care and home-liked environment was advocated in SCH. Comfort room with tranquil and homely environment was provided to dying patients and facilitated families to accompany residents walking through their end stage of life, but also maintained resident’s privacy and dignity.

Result & Outcome :

ACP signing rate was significantly increased from 0.01 % to 52%. Most often after ACP discussion, residents and relatives opted for receiving comfort conservative treatment in SCH. The rate of resident transfer-out to acute hospital was reduced by 64% per month. When compared with the data before the program, die in place had been greatly increased from 17% to 89%. Elderly friendly and person-centered cared were provided to the elderlies at their last journey of life.