Abstract

End-of-life care is increasing delivered in care homes by staff who lack specialist palliative care preparation. The Gold Standards Framework in Care Homes (GSFCH) provides care pathways and tools to plan and deliver end-of- life care and staff training. Evidence exists that links advanced care planning with improved outcomes: increased care quality; reduced crisis hospital admissions and increased achievement of preferred place of care (Hockley 2006; Badger et al 2007; Clifford et al 2007).

Methods
Realistic Evaluation was used to evaluate the impact of introducing the GSF in CH programme in two case study care homes in the North-West of England. Mixed data collection methods were used: quantitative measures included a pre and post training staff attitude scale, confidence log and an after-death analysis. Qualitative data were collected by interviews with 2 Care Home managers, 24 staff, 6 residents, 9 relatives and fieldwork observation.

Results
Care home staff had experience in providing end-of-life care; however many felt underprepared and lacked confidence in their ability to discuss and plan resident’s end-of-life care. Post-training staff reported increased knowledge, skills and confidence, and valued the structure, tools and training the GSF program provided. Support was needed for implementation.

Discussion:
End-of-life care quality in care homes can be improved through staff training and practice development. However, time is a scarce resource required to assimilate knowledge and skills, and implement change in practice. Current curricula need revision to provide the advanced level communication and practice skills required to provide high quality end-of-life care in care homes and other non-specialist care locations.