Rehabilitative palliative care in practice

Examples of innovation and good practice in rehabilitative palliative care.

Independent living suites to support self-management and rehabilitation

St Margaret’s Hospice in Taunton and St Margaret’s Hospice in Yeovil used a Department of Health grant to extend their inpatient units to include a one-bedroomed self-contained flat at each site (called Sunflower Suites). These ‘safe but separate’ facilities enable hospice staff to prepare patients (and their carers) more effectively for discharge home by offering a more independent living environment with replication of care services and equipment that will be available to the patient at home.

Sunflower Suites offer a ‘halfway house’ option so that self-management strategies can be tested, practiced and tweaked as necessary. Patients and families are supported to transition from a highly supportive ward environment to home with increased confidence, increasing the chances of a successful discharge. The suites are also used to support people admitted for palliative rehabilitation who are ready to benefit from a more independent living environment.

What inspired this innovation?

Moving back home from the safe environment of an inpatient unit can be a huge and frightening leap for some patients and their families. There is a great difference between the level of care and support that is available to our patients on the inpatient unit and that which is available in the community, even if a care package is provided.

We recognised that even when patients had apparently reached functional independence in the ward environment, their confidence (and often the confidence of family/friends) in their own ability to manage on their own was lacking. The flats give patients a perfect environment to demonstrate clearly to themselves, families and staff that all aspects of an appropriate and safe discharge have been duly considered and prepared as necessary.

Ensuring that we respond appropriately to patients’ wishes for their future sometimes means that risk assessment/risk taking is an essential part of discharge planning. Providing a ‘halfway house’ towards independent living provides a safer environment in which patients can really explore their functional boundaries and make informed decisions for their future.

What difference has it made to your team’s Rehabilitative Palliative Care?

Supporting a patient within a Sunflower Suite is a whole team effort – from the kitchen’s understanding whether they are continuing to provide meals or provision of supplies for the patient to cook their own food, to the volunteers knowing not to pop in to say hello if the patient is acclimatising to seeing no-one all day as it will be at home. We have seen team working at its absolute best.

Discharge planning has become even more focused and enabling. It is not only the patient that benefits from being in a more independent setting – those staff who were more used to ‘caring’ than ‘enabling’ have responded in such a positive way to support the rehabilitation process.

Patients have not needed such intense support from the community teams post discharge, as anxieties have already been addressed more comprehensively.

Karen Kidsley, Lead Physiotherapist/Therapy Coordinator, St Margaret’s Somerset Hospice

Alison Hodgson, Lead Physiotherapist, St Margaret’s Yeovil Hospice

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