Anticipatory hospice at home care

Project overview

Lewis-Manning Hospice Care, located in Dorset, serves the rural community of Purbeck.

Purbeck is located on a peninsula with limited public transport links and few main roads. There are community hospitals in the area, but no general/acute hospital. For many people, the best way to access care in Bournemouth or Poole is via the chain link ferry.

Lewis-Manning identified health inequalities among some residents in Purbeck, particularly due to geographic barriers. This prevented people with a palliative diagnosis from accessing support, which can put them at risk of crises and unnecessary hospital stays.

To address this issue, Lewis-Manning developed a new model of care, adapting its successful day hospice service and transferring it into the comfort and security of the patient’s home.

How it works

Patients can access the anticipatory Hospice at Home care in the same way as the day hospice (through a professional or self-referral). All new patients receive a comprehensive assessment, so that the hospice team can understand care priorities for them, their carers and families.

The anticipatory Hospice at Home model is a multidisciplinary service. Patients and families are offered a bespoke menu of support based on their care needs and what matters to them.

Services that can be provided in people’s homes include:

• occupational therapy
• physiotherapy led pulmonary rehabilitation
• advanced care planning and co-ordination of care
• complementary therapy
• creative activities using art as therapy
• respite care
• counselling services (family support and bereavement care).

Outcomes

Working in partnership with local GP surgeries, community hospitals and other stakeholders, the hospice is able to integrate people back into the support of their communities and healthcare system.

Hospice staff are able to help patients and care providers to understand palliative care while advocating for patient-centred goals and co-ordinated support. They can introduce the concept of advanced care planning and facilitate conversations as needed.

The anticipatory care model is working. Since it was introduced, there has been a reduction in the number of GP visits, ambulance callouts and hospital stays for patients with a palliative diagnosis. The hospice can demonstrate that this way of working saves money for the local Integrated Care Board (ICB). All of this has resulted in more clinicians becoming involved.

Patients, carers and GPs have given positive feedback about the service. As well as helping to prevent crises from happening, it reduces loneliness and helps people in rural areas stay in their preferred place of care.

Key faciltators

Lewis-Manning Hospice Care was grateful to receive a grant from St James’s Place Charitable Foundation via Hospice UK's grants programme in 2022/2023. This funded the initial project to develop the new anticipatory care model.

The hospice has now opened two day hospice hubs, each operate one day per week. One is hosted by a local cricket club and the other a local rugby club. These provide clinical advice, complementary therapy, occupational therapy, carers groups and bereavement groups. People have begun to use them as informal drop-in centres, which gives patients and carers a chance to socialise with their peers. This has been a very good way to refer people to the hospice at home services.

The hospice team have invested a lot of time in building relationships with local GPs. This includes attending Multi-Disciplinary-Team (MDT) and community meetings. This has been worthwhile, as it has resulted in more GP referrals.

The community in Purbeck is split into two main areas: Wareham and Swanage. Both areas are very community-focused, and people want to help each other. This means news about the hospice at home service has spread by word of mouth. Because the community is very active, the hospice team have been able to adapt the service to meet local need.

Challenges

Although extending services into rural areas is beneficial to patients and carers, it can be challenging for staff. It takes longer to travel to patients’ homes, and this needs to be considered when planning staff schedules.

It can be difficult to find a base for nurses to work from in a rural location, and if staff are working without a local base, they might feel isolated from their colleagues. Lewis-Manning has tried to address this by rotating staff from different teams into the more rural areas.

Lewis-Manning is looking to secure sustainable funding that will enable them to continue the service past March 2025.