Managing health changes for people with a learning disability in a residential care home setting.

BACKGROUND: People with learning disability (LD) have complex comorbidities that develop at an earlier age than the general population and with which they are now living longer. Identification, assessment and management of these conditions is important but challenging. AIM: To develop resources with care staff to enable them to recognise and manage changes and decline in the health of a person with a LD. METHODS: Two resources (PIP-LD and CIRC) were developed through undertaking a literature review; networking with experts; and collaborating with staff in the care homes for people with a LD. Care staff then used these resourcesto review their residents. FINDINGS: The PIP-LD and CIRC were used in 39 care homes. The PIP-LD empowered staff to meet people's immediate health needs, and the CIRC helped them to recognise changes or a decline. CONCLUSIONS: The combined use of the PIP-LD and the CIRC enabled care staff to recognise the signs and symptoms of each person's comorbidities early, and to identify and manage changes when their health declined.

Improving the approach to future care planning in care homes.

BACKGROUND:: There is international and national interest in the availability and provision of quality end-of-life care. In the UK this includes the promotion of advance care planning (ACP). AIMS:: To support care home staff to apply national policy on ACP in practice. METHODS:: A proactive document, the PErsonalised Advisory CarE (PEACE) plan, was created. An audit was undertaken of its implementation in practice in one care home. FINDINGS:: All of the residents with a PEACE plan who died (n=8) did so in their preferred place of care; only 50% of residents (3 out of 6) without a PEACE plan died in their preferred place of care. No family members declined the opportunity to have a PEACE plan conversation. CONCLUSION:: Future care planning, rather than ACP, is required in nursing care homes. Research investigating the outcomes and cost-effectiveness of undertaking these conversations is required to further guide national recommendations.

Development and implementation of the Steps to Successful Palliative Care programme in residential care homes for people with a learning disability.

BACKGROUND:: For health and social care services to meet the needs of a growing and ageing population they need to respond appropriately. This response is only going to be possible if attention is paid to the individuals within it. This includes those people living with a learning disability (LD). AIMS:: To develop and implement a palliative care programme that would meet the needs of people with a LD, their families and care home staff. METHODS:: A palliative care programme and resource folder was created following a literature review and meetings with LD and specialist palliative care experts, organisations and care home managers. This folder was further developed collaboratively throughout the programme's implementation. FINDINGS:: 39 homes were recruited and 86% completed the programme. CONCLUSIONS:: This programme enabled the identification, assessment and management of the health and social care needs of people living and dying in a care home with a LD.