1. Facilitator: Helen O’Neil Palliative Care Tutor: Jenny Lowe

2. Step One - Programme Welcome, housekeeping, session agreements Review Induction workshop homework Route to Success / Step One Objectives North West End of Life Care Tool – Case studies BREAK Introduction to Advance Care Plans and discussions about End of Life Care To do list Revisit objectives / Evaluations

3. Step One Objectives: Review Induction Further develop the care home end of life policy Identify how the North West End of Life Care model and tool supports an end of life care register Identify when is the appropriate time to undertake end of life care discussions considering capacity and communication barriers

5. Rainy day thinking “Hope for the best but prepare for the worst”

6. Approaching end of life Advanced, progressive, incurable conditions General frailty and co-existing conditions that mean they are expected to die within 12 months Existing conditions if they are at risk of dying form a sudden acute crisis in their condition It includes management of pain and other symptoms and provision of psychological, social, spiritual and practical support.

8. Identifying Residents who require end of life Focus on the resident's needs Right care at the right time Planning care for resident’s anticipated needs North West end of life care model used as a guide to aide the process Used to promote discussion and planning It is not intended to be accurate in prediction Resident’s can move up and down

9. Significant Events that may indicate change Reduced mobility Re-current falls More frequent hospital admissions Re-current infections Deterioration in swallowing General loss of interest from patient Loss of appetite

10. The Surprise Question “Would I be surprised if the person In front of me was to die in the next …year?” ?

11. Rainy day thinking “Hope for the best but prepare for the worst”

12. 20 minute comfort break

13. Advance Care Plan “Advance care planning (ACP) is a voluntary process of discussion about future care between an individual and their care providers, irrespective of discipline” It involves residents and their carers in discussions around end of life care and must be person-centred, never forced

14. Advance Care Planning. Discussion may include: Concerns and wishes Important values, care goals Understanding about their illness, prognosis Preferences/wishes for care in the future, availability of this care Documentation – Preferred Priorities for Care

15. 1. What might be the barriers to talking about Advance Care Plans? 2. How might you know when it’s the “right time?”

16. Advance Care Planning. Communication issues: Fear of making it happen Fear of upsetting residents, families, causing arguments Whose responsibility is it? (avoidance) Fear of being misunderstood/misquoted Upsetting - unleashing strong emotions Lack of knowledge / our vulnerability Difficult questions Invading privacy

17. When is the “right time?” It must be person-centred - timing is everything Opportunistic conversations Two weeks after they have arrived as a matter of course? “They’ve got this new programme in the North West that all care homes are doing”…. – what do you think?” Don’t forget, it’s an on-going dialogue Trust your intuition

18. Any Questions?

19. Our next meeting will be on 14 th March 1 – 5pm here in the Oak Centre (support day 20 th Feb 1pm-3pm if needed) Any queries please contact Helen O’Neil at the Hospice either by phone 01524 382538 by e-mail on: helen.oneil@northlancs.nhs.uk Don’t forget – everything you need is on www.endoflifecumbriaandlancashire.org.uk

20. Thanks for all your hard work today!