1. Palliative Care Home SupportLiving to the end21st Hospice New Zealand conferenceWellington, October 2014Rod MacLeod and Sally Yule 2. Seeking to Address the GapsPalliative CareHome SupportPackages48 hours end-of-lifehome careCare workers withspecialisedpalliative caretrainingOversight and CaseManagement byexisting SpecialistPalliative CareteamsState-wideEducation Palliative CareBridgeSpecialisedvocational palliativecare training forcare workers(RegisteredTrainingOrganisation)Professionaleducation forgeneralist trainedhealthcareprofessionals(Learning andResearch Centre)EvaluationService ProvisionEducation andTraining 3. Working Together for a Common GoalConsortium Collaborating with Medicare Locals 7 NSW LHDsSpecialist Palliative Care Teams Local community care providers Paediatric Palliative Care Network 4. MurrumbidgeeFar WestWestern NSWCentral CoastNorthern SydneySouth East SydneySouthern NSW 5. Model of CareSupporting living to the endWhere did we start?Local Palliative Care Teams Supplementing existingpalliative care work Guided by LHD expertsOpportunity to die at homePatient/family with desireto die at home(deteriorating/terminal phase)Choice and controlPatient/family inconsultation with localPalliative Care Team planneeds and preferences forend-of-lifeLinking and enablingLinks patients and localpalliative care teams withupskilled care workersFlexible support Available when thepatient/family chose Doing what thepatient/family needOutcomeEnd-of-life care shapedby the patient(different in every case) 6. Training ModulesModule 1 Essence of palliative care Ethical issues in palliative and end of life careModule 2 Grief and loss Self careModule 3 Pain and symptom management Last daysModule 4 CommunicationModule 5 Paediatric Palliative Care 7. A StoryUntil the final night I would greet her with: Good eveningM, I am Barbara and I will be with you all the night whileyour daughters sleep next door.For 8 nights I was sitting at her bedside from 10pm-6amand even when I thought she might be unconscious I wastelling her: I am leaving the room for a couple of minutes touse the bathroom or to get a cup of tea, will be back in acouple of minutes 8. A StoryDuring the last night she had lots of discharge comingfrom her lungs, and I had to wipe and change the napkinunder her face frequently.Her bible and songbook were on her bedside table - I tookher bible and read.After a long time reading I wondered if I should sing aspiritual song and I did. By the end of the song, M openedher eyes wide, moved her shoulders and changed herbreathing pattern 9. A StoryI woke the daughters. All four were with their belovedmum when she took her last breath - there was no rush, allwas peaceful and calm.I took the position of an observer only.After many tears, hugs and phone calls, I told them I wouldlike to reposition and clean Ms body. They wanted to helpso we spent some time making M and her room beautifulfor visitors to come in the morning.I left around 2:00 in the morning. 10. Palliative Care Bridge 11. Service Evaluation University linked Modified QODD Scale - UNSW Hospital bed days saved Interview follow-up with families,care workers and SPCT Longitudinal study on the impactof quality of death and dying onbereavement How was hope generated forfamilies?EvaluationServiceProvisionEducation andTraining 12. Education Evaluation University linked Care worker training - UNSW Palliative Care BridgeEvaluationService ProvisionEducationandTraining 13. Progress First package delivered October 2013 Packages delivered in all 7 LHDs 79% of patients died at home Ongoing care worker training MOUs with 16 community care providers Distributed 1,500 Palliative Care Handbooks Recorded 26 education videos for Bridge 14. Palliative Care Home Support Program keyelements in HC Consortium model1. Choice and control for patients and families2. Supplementary resources for SPCTs3. Supporting living to the endCommunication and collaboration withLHDs central driven by local palliativecare teams and patients 15. A HammondCare Consortium Service