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A living example of gold standard care at end of life

L-R: Liz Jones Policy Director National Care Forum, Rekha Govindan, Manager Chegworth Nursing Home, Shehzad Jivraj, Head of Operations, Clearstone Care

Supporting residents to live well right up until the end of their life is at the core of the operation of every good care home. For 20 years the National Gold Standards Framework Centre (GSF) has been supporting care homes to do just that. More than 3,000 homes have completed the programme with over 800 achieving accreditation.

In November 2019 Chegworth Nursing Home in Surrey was named Gold Standards Framework Care Home of the Year. Rekha Govindan, Manager and Operational Director at Chegworth explains how, 12 years after the home received its first GSF Quality Hallmark award, its residents and staff continue to enjoy the benefits.

“We started doing the Gold Standards Framework here at Chegworth in 2005 when I was deputy manager. Previous to starting work at the home I had worked as a cardiac nurse. I fell in love with elderly care as soon as I started here.

“When we started doing GSF it inspired the team and I to get more involved in end of life care. It helped open our eyes, to look at the patient as a whole and consider what they really want and need. The coding it provides helped us know exactly what stage the resident is at and what needs to be done. By following the framework step by step there will be no shortfall, and no one will fall through the cracks.

“We have 43 residents here at Chegworth and most of them are nearing the end of life, so we have between 35-40 deaths every year. In 2018, 37 of our residents died but only two did so in hospital. There are a number of reasons for this. Most importantly, our residents say they would like to stay in the home, so we do our best to keep them there.

“Recently we had a resident who was admitted to hospital when she had an acute stroke. But I advised the hospital that she wanted to be cared for in the home. So, as soon as they had stabilised her, she was discharged and then we looked after her until she died a week later – in her chosen place.

“By planning and assessing and picking up symptoms early we can avoid unnecessary hospital admissions which is better for the resident and frees up hospital beds. Another benefit is that it gives us all great satisfaction that we can provide the care the residents want, where they want it. Another factor is the excellent relationship we have with our local GP. We already had good ties with him, but GSF has helped us make that even stronger, so we can have anticipatory drugs on hand, and also call him at any time.

“A resident’s GSF journey begins on the first day they visit the home. At that point we’ll endeavour to learn as much as we can about them, and this will help us to create their advance care plan. That means that as soon as they move in, which could be the same day, we are prepared and ready to meet their wishes and preferences.

“GSF has helped us develop our end of life care skills to such a degree that two of our local hospitals, both St Hellier and St George’s, now choose to discharge their palliative care patients to us, confident that no matter how complex their needs, we will be able to provide them with quality care right up until the end.

“As well as the patients, the staff have benefitted too. Two of our most senior members of staff have been here more than 10 and 15 years and every time a new member joins the team, I do a one-to-one GSF session with them as part of their induction. It’s not just the care team that are involved either. We make sure that everyone is part of residents’ journey. The chef is kept informed of the coding, so they know that if a resident is ‘red’ not to prepare them meals but to provide refreshments for the relatives.

“In our latest CQC report, the inspectors wrote that our GSF training and fourth time accreditation meant staff continued to deliver end of life care in line with best practice. Through GSF we have taken huge satisfaction in looking after our residents here in the home right up until the time they die. It’s not like a hospital and no one will die alone in my care home.”

For more information about how to embed gold standard care for all residents in your home and to deliver NHSE Enhanced Health in Care Homes (EHCH) contacts carehomes@gsfcentre.co.uk or click here.

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