Regular, focused meetings to discuss the specific needs of nursing home residents requiring palliative care can reduce repeated hospitalizations and improve the quality of a person’s final days, according to new research out of the United Kingdom.
Researchers from England, Scotland and Australia collaborated on analyzing the impacts of Palliative Care Needs Rounds, which were first formally introduced in 2018 through the nonprofit healthcare organization Calvary Care, based in Sydney, Australia. The researchers found Needs Rounds boosted staff confidence as well as communication between the staff, physicians, and clinicians.
The study involved 29 care homes, which are the United Kingdom’s long-term care facilities.
“Care home residents often lack access to end-of-life care from hospice teams and so may experience distressing symptoms at end of life if care home staff cannot fully meet their needs,” the researchers wrote. “Needs Rounds build care home staff confidence and can strengthen relationships and trust, while using each services’ expertise. Needs Rounds strengthen understandings of dying, symptom management, advance/anticipatory care planning and communication between care home staff, families, specialist palliative care staff and primary care. This improves the quality of resident care, enabling residents to be cared for and die in their preferred place, and also benefits relatives by increasing their confidence in care quality.”
In an email to McKnight’s Long-Term Care News on Monday, Liz Forbat, the lead researcher and dean of Faculty of Social Sciences at the University of Stirling, Scotland, said the model could work well in the US She provided additional specifics on the conversations that take place during the meetings.
“If the resident needs it, then there may be a sequence of actions like: medicine review (to prescribe or deprescribe), an assessment by the hospice practitioner, education of the care home staff on a key issue (e.g. if the resident has COPD then they might do some anatomy/physiology education about pulmonary function and talk about pharmacological and non-pharma approaches to managing breathlessness),” Forbat wrote.
In the initial introduction of Needs Rounds, staff at a long-term care facility in Canberra, Australia, began meeting monthly for one hour at a time to discuss eight to 10 residents who were dying without an end-of-life plan in place. The monthly triage meetings identified residents with the greatest needs and were led by a palliative care specialist who educated care home staff on residents’ physiological, psychosocial and spiritual needs.
The monthly meetings included hospice staff to help educate facility staff on the particular care requirements in that specialty.
In 2020, Calvary Care, a Catholic healthcare provider, and the University of Stirling published an implementation guide for Needs Rounds to give facilities a “quick start” on the process, including a list of staff who should attend the monthly meeting, including nursing aides and activities coordinators. Forbat was also the lead researcher for this guide.
The new research, published last month in the Journal for Health and Social Care Delivery Research, found that Needs Rounds improved palliative care interventions. It comes on the heels of a study in the Journal of the American Geriatrics Society that found nursing home residents could greatly benefit from expanded access to palliative care, but providers need more access to standardized tools, education and specialty clinicians.
“Care home staff wish to reduce preventable hospitalizations, yet often lack clear methods of doing so,” the authors wrote. “Supporting the palliative care education of … staff (despite it not being part of statutory training) needs to be seen as a priority to improve outcomes both for staff and for residents requiring a palliative approach.”
