Interaction and collaboration between Martlets Hospice community-based services and the Martlets Care Agency, combined with the opportunities for respite admission to the hospice, have created a wonderful support network for social care clients.
Martlets Care was set up in 2007, primarily to provide a much needed income stream for the Martlets Hospice. However it soon became apparent that there was a wonderful opportunity to influence, for the better, the quality of social care for clients nearing the end of life.
Martlets Care, a wholly owned subsidiary of the Martlets Hospice, has the unique advantage of having the entire resources of the hospice at hand to support its care delivery and ensure a high quality service. We decided to create a social care agency model that was unique to the Martlets and which was based around the needs of the person first and foremost, mirroring the values of the hospice.
The stories below illustrate how the care agency has enabled the hospice to support a wider group of people than previously. It has greatly strengthened our links with social services and means that many more clients are able to receive the level of care they need so they can stay in their own homes.
Central to our success is the team’s experience, skills and knowledge in caring for people. Our clients have told me that they find comfort and assurance from knowing that every carer from Martlets Care has been trained by the hospice, and as a result the carers are better in tune with their needs, wishes and concerns and they are treated as individuals.
Only 52-years-old, George was a patient in the hospice but wanted to go home. The staff were concerned about how his care would be managed at home because he had complex care needs, including unresolved pain, he was also imminently dying.
He lived in a small one-bedroom flat on the first floor, with only a narrow staircase as access to the flat. He required careful manual handling before moving and he was bed bound at the time. He was also blind.
George was discharged home early December 2012, with support from hospice at home, community nurses and Martlets Care.
He required four care visits a day and three members of staff were needed to provide his personal care and change position in bed. The care agency worked hard to find carers for each visit and were able to support this level of care for the duration. The hospice occupational therapist ensured his transfer to his flat and up the narrow stairs was as comfortable as possible. The ambulance crew settled him into his hospital bed at home. Hospice at home visited daily in the evenings to monitor his symptoms and support his partner. He had a syringe driver running over 24 hours, to help with his symptom management which the team changed when they visited.
George actually settled at home very well. Without the care calls from Martlets Care this discharge would never have been achieved. His pain was better managed at home and we think he was more relaxed and felt safer in his home environment. His partner put up their Christmas tree early, although the patient could not see it he knew it was there. He was also pleased to be with his beloved pets – a dog and a cat that he had missed.
He died peacefully, after just over a week a home. This was possible only by responsive and collaborative working between health and social care.
Ray, an 82-year-old gentleman, was referred to hospice at home with heart failure. He was well known to the team and hospice as we had previously cared for his daughter.
He was initially referred in 2011, with an exacerbation of his symptoms which then settled. After which the ‘at home respite service’ provided regular respite support, so his wife was able to go out for short periods.
He was also diagnosed with bowel cancer later that year. He has diabetes, which is unstable at times.
The respite service, although managed by hospice at home, uses carers from Martlets Care. When Ray first starting having respite visits he was very low in mood and probably depressed, but the regular visits from the Martlets Care Carer cheered him up no end and gave him something to look forward to.
He became unwell again in May 2012, falling several times at home and with problems managing his diabetes. The carer liaised with hospice at home and discussed her concerns about his condition. Hospice at home visited and assessed him, arranging for admission to the hospice inpatient unit to manage his symptoms, and to give some respite for his wife.
He found the hospice admission useful and was discharged back home – his respite visits have continued. He has a regular carer with whom he gets on well and she feeds back to hospice at home if she has any concerns about him. He has very little support from other services, and this social care respite support is a lifeline for him and his wife.
Anne, an 87-year-old lady with Parkinson’s, was referred by social services to the respite service in March 2012. She had previously received respite from a nursing home but she had a very bad experience there and would not go again. She lives with her husband.
Anne is a retired children’s nurse. She has complex care needs, requiring four social care visits which involve the use of the hoist. She was referred so that her husband could have some time on his own, he enjoys going to the cinema. Anne requires two carers per respite visit, at present four hours a week are provided. We have been able to ensure continuity of the same carers each week.
Anne has also had a week’s respite stay at the hospice’s inpatient unit. The ‘at home respite’ visits continue which include an occasional massage.
There have been a number of challenges we faced in getting the domiciliary care business off the ground. The first was having the right staff, with the right balanced skill set, able to have on eye on the business objectives and one eye on service delivery. Smooth office processes and making maximum use of the rostering software to free up admin time has been an ongoing challenge which we are gradually getting to grips with. Managing the tension between the brand and reputation of the hospice, while establishing Martlets Care to be distinct and have its own brand identity and values has been an interesting journey.
It has been quite a learning curve getting to grips with the way the city council and social services operate. There seems to be a more rigid application of bureaucracy within social services and more constraints on the funding of care. It is easier to persuade the clinical commissioning group (CCG) to adapt or flex care packages and alter the funding appropriately. The clinical background of personnel within the CCG means that it is often easier to have a constructive discussion about a client’s needs. The funding per client from social services is much lower so from a business perspective it is less profitable taking social services clients. Having said all this we have been surprised by the level of complexity of social care that social services manage in the community.