57IDENTIFYING CARE HOME PATIENTS IN THE LAST TWELVE MONTHS OF LIFE

Abstract

Topic: In the UK 26.2% of care home residents die within 1 year. Patients in their last twelve months of life have more unplanned admissions and persistent symptoms as they become increasingly frail. On the Wirral Emergency Healthcare Plans (EHCPs) are used for anticipatory clinical planning, helping to reduce avoidable Hospital admissions. Established guidelines for recognising patients within the last twelve months of life are the Gold Standard Framework Prognostic Indicator Guidance (GSF PIG) and the Supportive and Palliative care Indicators Tool (SPICT). They both provide suggested general indicators of declining health. Objective: To identify how many patients > 75 years old admitted to Hospital under the elderly care team are from a care home and likely to be in the last twelve months of life. Method: Care home patients were identified from medical admissions over 12 days. Based on the aforementioned guidelines the following factors were identified; number of admissions in the last 6 months, deteriorating functional status and mobility status, presence of pressure sores, communicative state, oral intake and swallowing problems. Results: 420 patients >75 years old were admitted under the medical team over 12 days. 53 (12.6%) patients were from care homes. 28 were Nursing Home residents and 25 from a Residential Home. 10/53 (18.9%) of patients were assessed as being likely to be in the last twelve months of life. Eight of these patients were from a Nursing Home, two from Residential Homes. Two of the patients identified as being in the last twelve months of life died during their Hospital admission. A further eight patients, who did not meet the criteria, died during their admission. Therefore 33% of patients in the sample were likely to be in the last twelve months of life on admission to Hospital. None of these patients had an EHCP in place. Discussion: Based only on information gained at admission 18.9% of patients could be identified as being in the last twelve months of life by using general indicators for deteriorating health. Further training of care homes with the Six Steps End of Life Programme would increase identification of such patients, prompting consideration for EHCPs if appropriate. This would lead to better patient care and reduction of avoidable distressing Hospital admissions.