UNBEKNOWN to most, Prospect is one of only a handful of hospices in the country with a dedicated team of nurses charged solely with looking after patients reaching the end of their lives in care homes.
The team, which initially started with just one nurse in 2009, now has three staff caring for elderly residents in around 40 residential homes and assisting their care workers to cope with and understand complex terminal illnesses.
The hospice nurses treat on a daily basis through a drop-in centre, in-patient unit or out in the community. Care home patients often present an added challenge as they suffer not only from life-limiting illnesses but other long-term conditions such as dementia.
This can complicate their care as few are able to point to the origin of their pain.
“Someone with dementia may have pain but they may not be able to express it verbally,” said Sarah Powell, one of three clinical nurse specialists working in care homes. “Other people we support at the hospice may have one illness but here they often have multiple illnesses and they have a different set of needs.
“It’s like detective work. You have to pick up a lot from non-verbal behaviour and we try to work with their families and GPs to help them.”
In these circumstances, working closely with care home staff is essential and a task Prospect Hospice takes extremely seriously. “It’s about our team working closely with staff within care homes because they know residents well,” said Catherine Piggin, clinical nurse specialist team leader. “It’s really about knowing what is normal for them and noticing any changes. Many are frail and vulnerable at the end of their lives and have multiple illnesses.
“A lot of what the team is doing is enabling and empowering care home staff to deliver the care. We do this through education and increasing skills and confidence. We really want to invest in this whether it is through a session at the hospice or by answering their questions and helping them in care homes.”
While providing emotional support to patients and families is crucial to hospice staff at every level of the charity, the care homes team must also ensure care workers’ needs are met in order for them to look after their charges to the best of their ability.
“We provide direct emotional support to residents living in care homes but we provide a lot of support to the care home staff,” added Catherine. “They are often attached to the patient and it can be hard for them. They are the extended family often.”
More recently the team started visiting patients in need of palliative care also suffering from mental health problems or with learning difficulties. This has been a learning curve but one which has taught Sarah never to take anything for granted.
“We and care home staff are all learning together and from each other. Patients may not shout for help. Establishing trust with both patients and staff is very important. It has been challenge but it is also very interesting and rewarding. It’s really a privilege to do this work and we are very lucky.”